Dance West Registration

There is a $30.00 non refundable registration fee and a $25.00 non refundable registration fee for Kinder Programs.

Please note, if you choose to fill this form out online, you still must come into the studio to finish the registration process. You are not fully registered until your registration fee is paid and you have given your post-dated cheques for the year.

This deposit will be applied to Septembers fees. There is a $25.00 charge for returned cheques.

Date:

Student Name:

Birth Date:

Age:

Parent Or Guardian:

Address:

Home Phone:

Cell Phone:

Work Phone:

Emergency Name:

Emergency Phone:

Parents Email:

Family Doctor:

Allergies:

Care Card Number:

Please advise of which class or classes on the current schedule you are interested in:

LIABILITY WAIVER

BY CHECKING THE BOXES AND ENTERING MY NAME BELOW I AM INDICATING MY INTENT TO ELECTRONICALLY SIGN THIS WAIVER AND I WAIVE DANCE WEST AND ITS INSTRUCTORS OF ANY LIABILITY DUE TO INJURY. I ALSO UNDERSTAND THAT DANCE WEST IS NOT RESPONSIBLE FOR ANY BODILY INJURY TO ANY PERSON PRACTISING, INSTRUCTING, OR PARTICIPATING IN ANY PHYSICAL TRAINING, SPORT, ATHLETIC ACTIVITY OR CONTEST.

Electronic Signature

Please type your name in the spaces below to electronically sign your waiver:
First Name: Last Name:

Please re-type your name in the spaces below to confirm your electronic signature:
First Name: Last Name:

On (mm/dd/yyyyy)

I AGREE

I allow any photos taken of my child to be used for promotional purposes.
Yes No

COMPETITIVE AND EXAM STUDENTS ONLY
AGE AS OF JANUARY 1ST:
YEARS OF COMPLETED TRAINING:
BALLET:	JAZZ:	LYRICAL:	HIP HOP:
MODERN:	STAGE:	TAP:	ACRO:

Dance West Registration

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