Register Online – Registration Opens February 1st 2018

Availability:

Session 1 – July 9th – 13th

5-7 years
8-10 years 
11-13 years 

Session 2 – July16th – 20th

5-7 years
8-10 years
11 – 13 years 

Session 3 July 23rd – 27th

5-7 years
8-10 years 
11-13 years 

Session 4 July 30th  – August 3rd

5-7 years
8-10 years 
11-13 years

Session 5 August 20th – 24th

5-7 years 
8-11 years

Session 6 August 27th – 31st

5-7 years
8-11 years 

PAYMENTS:

Payment can be made by cheque, cash, or email money transfer to briana@guelphdance.com

To Pay by Visa or MasterCard please call (519) 822-2697

* are required

Family Information

First Name: *

Family Last Name: *

Primary Phone Number: *

Primary Email Address: *

Mailing Information

Street Address:

City:

Province:

Postal Code:

Student Information

Student 1

Name: *

Age: *

Date of Birth: *

Allergy/Health Info:

Session Request: *

Age Group: *

T-Shirt Size: *

Student 2

Name:

Age:

Date of Birth:

Allergy/Health Info:

Session Request: *

Age Group:

T-Shirt Size: *

Student 3

Name:

Age:

Date of Birth:

Allergy/Health Info:

Session Request: *

Age Group:

T-Shirt Size: *

Contact Information

Mother

Name: *

Work Phone Number:

Cell Phone:

Father

Name: *

Work Phone Number:

Cell Phone:

Emergency Contact

Name: *

Phone Number: *

Relation to Student: *

Doctor

Name: *

Phone Number: *

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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