Dance Class Registration

YOUR CHILDS INFO

Last name

First name

Age

Date of birth

Gender
MaleFemale

Address

APT#

City

Postal Code

Email Address

Tel.# (Daytime)

Tel.# (Evening)

Emergency Contact

Tel.#

Mother/Father's name

Please notify us of any medical conditions and/or allergies:

DANCE CLASSES

Class Name

Hours / Week

Total:

PAYMENT

The payment must be received with the registration form.
The full amount of classes needs to be paid in full by April 1 2018.
Cheques payable to: Danse 1...2...3 .NSF cheques are subject to a $25.00 charge and payment replaced within 7 days by interac or cash.
Monthly payments only by post-dated cheques on the 1st of every month. Late fee of 10$ if payment received after the 1st of the month.
Option of 2 payments: one payment upon registration, 2nd payment by Jan 1st 2018.

Signature

Date

AGREEMENT / RELEASE FORM

I, , consent that with any physical activity there are risks of injuries. I herby release Danse 1…2…3 and all instructors under its direction from any liability towards injuries that I and/or my child/children may incur during the course of my and/or their involvement in a class performance of any kind.

Signature:

Date

PHOTO AND VIDEO RELEASE FORM

I hereby authorize Danse 1…2…3 Inc., its representatives, staff, and employees, the right to take my photograph(s) and video(s) in connection with my registration at summer camp. I also authorize Danse 1….2…3 Inc., it`s assignees and transferees the right to copyright, use and publish the same in print and/or electronically, and all other multimedia medium. I also agree that Danse 1…2…3 Inc, may use such picture(s) and video(s) with or without mention of my name for publicity, illustration, advertising, and Web content including Danse 1…2…3 Facebook page, Danse 1…2…3 web site and other social medias.

I have read and understood the above:

Signature (18yrs & over)

Parent/Guardian Signature (under 18yrs old)

Date

CANCELATION FEE

A class will be considered cancelled once you inform us in writing.
Classes will be charged 18$/h (no matter what the amount of hours is per week) from the beginning of the session to the date that we are informed that you are cancelling.

Signature

Date