I/We release âStudio Câ and its employees from any and all claims and demands for damages, loss or injury, which may
Studio C Registration Form 2017/2018 STUDENT NAME: _____________________________________________________________________ ADDRESS: __________________________________________CITY:____________________________ POSTAL CODE: ___________________ PARENT NAMES: __________________________________ TELEPHONE: ________________________ CELL PHONE: ___________________________________ DATE OF BIRTH: _______________________________________ Month
Day
AGE: _________________
Year
EMAIL ADDRESS: ____________________________________________________________________ Please list any medical conditions your son/daughter has that the instructor should be aware of (ie) asthma, epilepsy, learning ____________________________________________________________ ACRO
BALLET
CELTIC
COMBINATION
JAZZ
TAP
LYRICAL
I/We release “Studio C” and its employees from any and all claims and demands for damages, loss or injury, which may be sustained by me, our son or daughter, while participating in any activity with “Studio C”. We voluntarily assume all risks connected with these dancing activities. I do hereby give Studio C and its legal representatives the right to use my son/daughter’s picture for advertising and information purposes, in all forms and media, including but not limited to: the studio website, social media and print publications. I waive any right to inspect or approve the final product, including written copy which may be created in connection therewith.
DATE: __________________________ SIGNATURE: _______________________________________ PAYMENT - Costume Included In Monthly Fees 9 monthly installment payments due by the 10th of each month $486.00 season fee divided into 9 payments = $54.00 each (first payment due at registration) ($47.79 dance fee + $6.21 HST = $54.00 per month x 9 months = $486 season fee) ** Private class $75.00 per month for ½ hour class ($66.37 dance fee + $8.63 HST = $75.00) ** Semi-private /trio class $65.00 per month per student for ½ hour class ($57.52 dance fee + $7.48 HST = $65.00) Do Not Complete CLASS: _______________________ DAY: __________________ TIME: _________________ CLASS: _______________________ DAY: __________________ TIME: _________________ CLASS: _______________________ DAY: __________________ TIME: _________________
