Online Registration
Name: Date of Birth:Grade: School: Address:Town: Postal Code:Phone: Cell:E-mail:Please indicate who will receive receipt to claim Child Fitness Tax Credit (if more than one please add $5 additional processing fee) Mother's Name: Work Phone:Father's Name: Work Phone:Medical Conditions / Allergies:Medicare #:Class(es) you wish to register for:Florenceville : Perth: Woodstock: WAIVER OF LIABILITY AND RELEASE
This is a waiver of Liability and Release of your rights to commence legal action. This Waiver and Release may be used against you in court if you commence legal action against any released party or person PLEASE READ THE FOLLOWING VERY CAREFULLY.
THE UNDERSIGNED ACKNOWLEDGES AND AGREES AS FOLLOWS:
The registered participant, or in the case of a minor, their parent(s) or guardian(s) agrees to indemnity and hold harmless Smith's Dance Academy and any instructors associated with Smith's Dance Academy, from and against any and all liabilities, claims, actions, damages, costs or expenses of any nature whatsoever, whether in law or equity, known or unknown, incurred by Smith;s Dance Academy and arising out of or in any way related, directly or indirectly, to participation in classes and instructions delivered by Smith's Dance Academy. By registering with Smith's Dance Academy, I agree to the terms outlined in this Liability Waiver and Release. I also agree to abide to all of Smith's Dance Academy policies and regulations. I further understand and accept that no promises or guarantees are made, explicit or implied.
The undersigned participant signs this Waiver of Liability and Release on the th day of , 2010 in the city/town of . By signing this Waiver of Liability and Release the undersigned acknowledges that he or she is giving up important legal rights and that this Waiver of Liability and Release may be used as a bar to or in defense of any legal action that may be commenced by me and/or my heirs, executors, administrators and assigns.
Participant or Parent / Guardian Digital SIgnature (if participant is under 19 years of age) (Type in Name)
STEP 1: Complete Registration Form
STEP 2: Complete Payment
Registration Fee : $20 (HST Included) per family
Add a second recepient for receipt of Child Fitness
Income Tax Credit $5 (HST Included)Costume Fee: $84.75 (HST Included) per dancer
Classe Fees: (Full Year Tuition - discount )
FLORENCEVILLE
Pre-School Tap Only $186.45 ( HST Included)
15 Min Ballet Add On $ 62.79 (HST Included)Grade K-1 Jazz, Tap & Hip Hop $243.80 (HST Included)
15 Min Ballet Add On $ 62.79 (HST Included)
Grade 2-4 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included)
Grade 5-7 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included)
Teens Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included)Boys Only HipHop (half year -14 weeks) $ 68.26 (HST Included)
PERTH
Pre-School Tap Only $186.45 ( HST Included)
15 Min Ballet Add On $ 62.79 (HST Included)Grade K-1 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 Min Ballet Add On $ 62.79 (HST Included)
Grade 2-4 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 Min Ballet Add On $ 62.79 (HST Included)Grade 5-7 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included)
Teens Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included) 15 min Flexibility Add on $ 32.65 (HST Inculded) (half year -13 classes)WOODSTOCK
Pre-School Tap $186.45 ( HST Included)
15 min Ballet Add On $ 62.79 (HST Included)Grade K-1 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 Min Ballet Add On $ 62.79 (HST Included)
Grade 2-3 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 Min Ballet Add On $ 62.79 (HST Included)Grade 2-4 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 Min Ballet Add On $ 62.79 (HST Included)Grade 2-5 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 Min Ballet Add On $ 62.79 (HST Included)Grade 4-5 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included)
Grade 5-7 Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included)
Teens Jazz, Tap & Hip Hop $243.80 (HST Included)
$243.80 (HST Included) 15 min Technique/Ballet Add On $ 62.79 (HST Included) STEP 3: Review the Policy Book and Print Your Costume Order Form
Your finished! You will recieve an e-mail confirmation of your registration in 1-2 days. Thanks for joining the fun at Smith's Dance Academy!
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