Session 1: September 26th – November 28th 2018Session 2: January 16th – April 3rd 2019

Student Details

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First Name:

Last Name:

Gender: FemaleMaleOther

Birth Date (yyyy-mm-dd):

Phone Number:

Email Address:

Street Address:



Postal Code:

Any known allergies?

Contact Information

Parent 1

Work Phone Number:
Cell Phone:

Parent 2

Work Phone Number:
Cell Phone:

Additional Details

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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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