2015 – 2016 REGISTRATION CHILD’S NAME: DOB: PARENT’S NAME: PHONE: MAILING ADDRESS: CELL: EMAIL: list all emails you want info sent to EMERGENCY PHONE: MEDICAL/ALLERGY ALERTS: EMERGENCY NAME: CLASS NAME CLASS DAY CLASS TIME ADDITIONAL INFO Please provide us with any additional information that you feel that will assist us in providing the best instruction for your child. It is extremely important for you to tell us of any challenges your child has or what makes them tick. We want to create the best learning environment for your child. All information is important. WHAT I WANT MY CHILD TO GAIN FROM CLASSES: REGISTRATION FEE - $30.00 PER CHILD OR $45.00 PER FAMILY + GST – (NON-REFUNDABLE) – Prior to June 30th $35.00 PER CHILD OR $50.00 PER FAMILY + GST ( NON REFUNDABLE) – After July 1st FOR OFFICE USE ONLY SharePoint Additional Comments Email Entered Added to Group Entered on Class List Payment Type Newsletter Sent Breakdown: Costumes added Reg Fee Added Liability Waiver Form I/we realize that participation in dance classes and activities could involve some possible personal injury and, I/we assume all risks related to the use of any and all spaces used by Adagé Studio. I/we agree to release and hold harmless Adagé Studio including its teachers, dancers, staff members and facilities used by both entities from any cause of action, claims or demands now and in the future. I/we will not hold Adagé Studio liable for any personal injury or personal property damage which may occur on the premises before, during or after classes. I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Adagé Studio. I understand that Adagé Studio is a licensed, accredited and insured organization. In the event that I/we observe any unsafe conduct or conditions before, during or after my/our classes, I/we agree to report this to an instructor or staff member as soon as possible. PARTICIPANT’S NAME: AGE: PARENT/GUARDIAN’S SIGNATURE: PHONE: PARENT/GUARDIAN (PRINT): DATE: Photo/Video Release I hereby give permission for images of my child, captured during regular and special Adagé Studio activities through video, photo and digital camera, to be used solely for the purposes of Adagé Studio promotional material and publications and waive any rights of compensation or ownership thereto. PARTICIPANT’S NAME: AGE: PARENT/GUARDIAN’S SIGNATURE: PHONE: PARENT/GUARDIAN (PRINT): DATE: Communication Policy We send all important information to you through email. This includes, monthly newsletters, updated class information, schedule changes and show information. It is important that you check your email regularly to ensure you are receiving the messages. Please make sure we have updated email information. Please make sure you add the studio emails to your contacts so we are not put in your spam folder. You consent to this information being sent and that you agree to read the information sent. You agree and understand that all important information regarding Adagé Studios is sent via email and you agree to check your email and read the newsletters and communications from Adagé Studio on a regular basis. The Studio will not be held liable for newsletters and information you did not read. All past newsletters can be found at www.adagestudio.com/students. If you do not have email it is important that you inform us in order for us to make other arrangements with you. Closure Policy SNOW DAYS: PLEASE check our website for updates throughout the day as we may need to close in order to keep our students safe. If School District #79 is closed for the day due to weather, we follow their policy and will NOT hold classes that day. Please remember that many of our instructors live in Victoria and Nanaimo and even though you may be able to get to the studio they may not be able to. Please check the website prior to coming to the studio on any snow days. Cancellation & NSF Policy No refund will be given after December 15th for Costume Deposits. 30 day written notice must be given to withdraw from class. No refunds will be given for withdrawals after March 1st: 4. NSF CHEQUES & DECLINED CREDIT CARDS WILL BE CHARGED A $40.00 FEE. 1. 2. 3. Studio Policies I have read and understood the studio policies and I agree to the terms