Registration Form www.artfoundation.ca Name: (First) ____________________________ (Last) _________________________________ Age:_______________ Parent(s) Name:___________________________________________________________________________________ Mailing Address (Apt#, Street, City) : __________________________________________________________________ Postal Code: _______________ EMAIL (for updates only): _______________________________________________ Contact # (Daytime) ______________________________Contact # (Evenings) _________________________________ Ms. Serena’s Secrets (The Masters Class Continues…) Ballet/Bun Making/Stage Makeup May 26th – May 29th, 2015 Maggie Porozni Foundation for the ARTS (4822- 50 Ave, St. Paul, AB) Please Check all Applicable Classes. St. Paul & District Arts Foundation Members deduct $10 off per class. Ms. Serena’s Secrets…… (Shhhh!!) DATES: May 26th – May 29th, 2015 *Ballet Experience Required o5‐8 Year olds 4:00pm‐5:00pm $70 o9‐12 Year olds 5:00pm ‐6:30pm $100 o13 Years + 6:30pm‐8:30pm $130 EEA COURSE REGISTRATION AVAILABLE ON OUR WEBSITE AT WWW.ARTFOUNDATION.CA OR VIA EMAIL : [email protected] page 1 of 3[EARTH WITHOUT ART IS JUST 'EH']08:40:00 Registration Form Freedom of Information and Protection of Privacy Act I/we hereby acknowledge and agree that the information requested on the registration form was provided by me and will be used by the St. Paul and District Arts Foundation Board or Committee Members and/or Instructors to contact me regarding matters related to my child’s classes, rehearsals, and performances. I/we acknowledge that we may advise the St. Paul & District Arts Foundation Board in writing that we do not wish this information to be used in any way, however this may result in my not being informed of matters relating to my child’s classes, rehearsals and performances. I/we hereby acknowledge and agree that the student’s name, photo and or likeness may appear in print or video material the St. Paul and District Arts Foundation may sell and/or use in advertising. I/we also acknowledge that I/we may request the student’s name, photo and/or likeness not be used but such a request may result in the student’s exclusion from events that could result in their name and/or likeness being used. I/we hereby agree that the above waiver is intended to meet whatever requirements may be in existence pursuant to the Freedom of Information and Protection of Privacy Act. Signature of Parent/ Legal Guardian or Student (if 18 years of age or older) __________________________________________________ Date _____________________________ page 2 of 3[EARTH WITHOUT ART IS JUST 'EH']08:40:00 Registration Form Waiver and Release ‐ St. Paul & District Arts Foundation Student Name: ____________________________________________ Assumption of Risk In consideration of my being allowed to participate in the St. Paul & District Arts Foundation, I the undersigned, hereby agree and acknowledge the following: Assumption of risk ‐ I hereby acknowledge, accept and agree that participation involves inherent risks. I received full information and opportunity to see the building/classroom and ask any questions that I wished. I have full knowledge of the nature and extent of all the risks associated with participation. Release ‐ I hereby release and discharge the St. Paul and District Arts Foundation, it's owners, affiliates, agents and employees and their successors and assigns, from any and all liabilities, suits, claims and demand actions or damages (including Attorney's fees and disbursement) incurred by me arising out of my participation in the courses, including without limitation, all claims for property damage, personal injury, or wrongful death, except to the extent that such loss or damages are caused by or resulting from gross negligence of any such party. This release is binding upon my heirs, assigns and agents. Indemnification I hereby agree to indemnify and hold harmless the St. Paul And District Arts Foundation, it's owners, affiliates, agents and employees and their successors and assigns from any and all cause of actions, claims, demand losses and costs of any nature whatever arising out of or in any way relating to my participation, except to that the same is caused by or results from gross negligence of any such party. This indemnification is binding upon my heirs, assigns and agents. Agreement to follow Code of Conduct and Course Participation Policies of the St. Paul & District Arts Foundation. I accept full responsibility for my own safety while participating in the St. Paul & District Arts Foundation classes. I agree to abide by and enforce all policies. a) All guests and students must be familiar with the St. Paul & District Arts Foundation policies, and must have signed and filed this form with the St. Paul and District Arts Foundation to be allowed to participate in the classes. 2) As part of this agreement, my consideration and participation in St. Paul & District Arts Foundation activities, I acknowledge with my signature that I have read and agree to abide by the terms of the waiver. Signature of Parent / Legal Guardian or Student (if 18 years of age or older) ______________________________________________ Date _________________________ Signature of St. Paul & District Arts Foundation Member ______________________________________________ Date _________________________ page 3 of 3[EARTH WITHOUT ART IS JUST 'EH']08:40:00