Registration  for Dance Season 2008-2009

Student's Name  Age  Birthdate(day/month/year)

Mother's Name   Father's Name

Mailing Address  City     Postal Code

Home Phone  Work Phone  Cell Phone

Email Address(Will only be used for newletters, and other information relating to classes)

Class(es) registering into: (Please include day and time of class)

   

     

For Levels 2 through to Senior Level please indicate if you are interested in the following:

Ballet Examinations           Performing in a Children's Ballet        Dance Conventions/workshops              All              None        

 

I have read and accept the policies on refunds, recital, adminstrative and costume fees  

Payment submitted:

(Cheques payable to "Susan Paisley School of Dance")

Full payment for the year:   or

2 equal payments of            or

9 post-dated cheques for   each - dated the first of each month

Plus:  

Costume fee(s)                  (non-refundable after October 15th, 2008)

Late Registration Fee:  $10.00

Waiver and Release of Liability

In consideration of the Susan Paisley School of Dance registering me for this and subsequent years, the undersigned acknowledges and agrees that:

  1. The risk of injury from this activity, although nominal, is present, and while training and instruction may reduce this risk, the risk to injury does exist; and

  2. I knowingly and freely assume all such risks, both known and unknown and assume full responsibility for my participation and/or my child(ren); and

  3. I, for myself and/or my child(ren) and behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless the Susan Paisley School of Dance its agents or employees, and if applicable, owners, lessors of the premises used to conduct the dance activities ("releases") with respect to any and all injury, disability, death, or loss to person or property.

I have read this release of liability and assumption of risk agreement and have accepted the terms.

Parent/Guardian signature:_____________________________________________

Witness signature:__________________________________________________

Date:__________________________________

To print form: Open "file" menu, and select "print"

Completed forms with  full payment can also be sent to:

Susan Paisley School of Dance

P.O. Box 143 Armstrong B.C.  V0E 1BO