PD Day Camp Registration

All fields are required

Family Information

First Name:
Last Name:
Phone Number:
Primary Email Address:

Mailing Information

Street Address:
City:
Province:
Postal Code:

Student Information

Student 1

Name:
Age:
Date of Birth yyyy-mm-dd:
Allergy/Health Info:
Age Group:
Gender: FemaleMaleOther
Currently a student? YesNo

Camp Days for Student 1

Friday September 29th, 2017
Friday October 27th 2017
Friday November 24th 2017
Friday January 26th 2018


Student 2

Name:
Age:
Date of Birth yyyy-mm-dd:
Allergy/Health Info:
Age Group:
Gender: FemaleMaleOther
Currently a student? YesNo

Camp Days for Student 2

Friday September 29th, 2017
Friday October 27th 2017
Friday November 24th 2017
Friday January 26th 2018


Student 3

Name:
Age:
Date of Birth yyyy-mm-dd:
Allergy/Health Info:
Age Group:
Gender: FemaleMaleOther
Currently a student? YesNo

Camp Days for Student 3

Friday September 29th, 2017
Friday October 27th 2017
Friday November 24th 2017
Friday January 26th 2018

Contact Information

Parent 1

Name:
Work Phone Number:
Cell Phone:

Parent 2

Name:
Work Phone Number:
Cell Phone:

Emergency Contact

Name:
Phone Number:
Relation to Student:

Doctor

Name:
Phone Number:

Additional Details

All fields are required
Payment Options:

The undersigned agrees to save harmless, indemnify and release The Guelph Academy of Dance(the “School”), its proprietor, employees, volunteers, administrators and assigns (the “Releasees”) from and against liability and actions including but not limited to any act, error or omission on the part of the Releasees. The undersigned acknowledges the risks of the instructional program and voluntarily assumes all such risk. The undersigned further covenants and agrees not to join or assist in any manner with any other person in the making of any claim or demand against the Releasees and School arising out of or in relation to the matters here-in-before remised, released and/or discharged. The undersigned authorizes the School to take all reasonable steps to respond to a medical or other emergency, including but not limited to the providing of immediate first aid and obtaining professional medical assistance.

I have read, understand and agreed to the foregoing terms and conditions.

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