Class REGISTRATION

Student Name

First Name

Last Name

Student Age

Date of birth

Allergies/Medical Conditions

Parent / Guardian

Parent / Guardian Name #1

(for class notices, etc. – please use one you check frequently)

Phone Number

Parent / Guardian Name #2

Email (2nd Guardian)

(for class notices, etc. – please use one you check frequently)

Phone Number

Mailing Address

Address Line 1

Address Line 2

City

Province

Postal Code

Class(es) Enrolled

Complete for each class of enrollment

Class

Day

Time

Hours

Class

Day

Time

Hours

Class

Day

Time

Hours

Class

Day

Time

Hours

Class

Day

Time

Hours

Class

Day

Time

Hours

Class

Day

Time

Hours

Class

Day

Time

Hours

Class

Day

Time

Hours

Total Hours Per Week:

Subtotal of Fees

Less Family Discount

(if applicable)

Monthly Payment

(if applicable)

Preferred Payment Method

Post-Dated Cheques

Cash

E-Transfer

Consent Agreement

Island Dance Academy will not assume responsibility for any injury resulting from misuse of equipment or failure to comply with the instructions of our staff. I hereby certify that my child is in good physical condition and is able to participate fully in this program. All current and up to date physical conditions are outlined above.

By checking this consent box I the parent or guardian of, release Island Dance Academy and its teachers from liability in case of accident or injury that may occur while attending classes at Island Dance Academy on or off site. I have also read and understand the School policies.

Refund Policy And Withdrawals
There are NO REFUNDS. Your payment and registration are an agreement between yourself and Island Dance Academy for a stated period.
You are advised that you are responsible for the full payment of a term for which you are registered. Invoicing will continue until IDA is notified by email, that the student will not be returning.

I Agree

PLEASE BE ADVISED that classes may be documented by photo and video. These may be used for publicity purposes. If you do not want your child’s image to be used, please check here:

I do not want my child's image to be used