REGISTRATION FORM
	2009-2010
Grade					Date of Birth
Address
City/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	¨	Father	¨	Other
Mother's Name					Work Phone
Father's Name					Work Phone
Allergies / Medical Conditions
Class(es) you wish to register for:
Florenceville:					Perth:
¨	Wed 5:15-5:45 Pre-School Tap				¨	Mon 5:15-6:45 Pre-School Tap
¨	Wed 5:45-6:00 Pre-School and K-1 Ballet				¨	Mon 5:45-6:00 Pre-School and K-1 Ballet
¨	Wed 6:00-6:45 Grade K-1				¨	Mon 6:00-6:45 Grade K-1
¨	Wed 4:15-5:15 Grade 204				¨	Mon 4:15-5:15 Grade 2-4
¨	Wed 6:45-7:45 Grade 3-5				¨	Mon 3:15-4:15 Grade 4-7
¨	Wed 3:15-4:15 Grade 4-7				¨	Mon 6:45-7:45 Teens
¨	Wed 7:45-8:45 Teens				¨	Mon 7:45-8:45 Adult Fun Fit
¨	Wed 8:45-9:30 Fun Fit
Woodstock
¨	Tue 5:30-6:15 Pre-School Tap and Ballet				¨	Wed 8:30-9:30 Teens
¨	Tue 8:15-9:15 Teens				¨	Thur 11:00-11:45 Pre-School Tap and Ballet
¨	9:15-9:30 Grade 6 & Up Technique				¨	Thur 5:00-5:45 Grade K-1
¨	Wed 5:00-5:30 Pre-School Tap Only				¨	Thur 5:45-6:45 Grade 2-3
¨	Wed 5:30-6:15 Grade K-1				¨	Thur 4:00-5:00 Grade 4-5
¨	Wed 4:00-5:00 Grade 2-3				¨	Thur 6:45-7:45 Grade 6-7
¨	Wed 6:15-7:15 Grade 4-5				¨	Thur 7:45-8:15 Gr 6 and Up Technique
¨	Wed 7:15-8:15 Grade 6-7				¨	Thur 8:15-9:15 Teens
¨	Wed 8:15-8:30 Grade 6 and up Technique
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 _________________, 2009 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.
Print Witness's Name				Witnesses Signature
Print Participant's Name				Participants Signature (if 19 years of age or over)
Print Parent/ Guardian's Name ( if participant is under 19 years of age)				Parent/ Guardian's Signature ( if participant is under 19 years of age)