PA Day Registration If you are human, leave this field blank. Dancer's Details Child's Name * Extended Hours Needed * Medical Conditions (if any) * Add Another Child? Yes No Child's Name Extended Hours Needed Please include AM & PM Medical Conditions (if any) Add Another Child? Yes No Child's Name Extended Hours Needed Medical Conditions (if any) Any additional comments or concerns we should be aware of? Parent and Home Information Parent Full Name * Main Phone Number Contact * Parent Work Number Main Email Address Contact * Main Address * Main Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City City Province Province Postal Code Postal CodePayment Details Method Of Payment * Visa Mastercard Post-Dated Cheques How did you hear about the studio? Clarington This Week Flyer Yellow Pages Friend / Neighbour Studio Signage Website Other How did you hear about the studio? Informed Consent Agreement * I/We, the undersigned hereby acknowledge that certain Risks of Injury are inherent to participation in dance, performance and recreational activities. These types of injuries may be minor or serious and may result from one’s actions, or the actions of others or inaction of others, or a combination of both. I/We understand that the Studio Guidelines are designed for the safety and protection of participants and hereby undertake to abide by these rules and regulations. I/We hereby warrant being physically fit to participate and understand that the choice to participate brings with it the assumption of those risks and results, which are part of these activities. I/We agree that Spotlight DanceWorks Inc. or its employees or agents shall not be liable for any injury to my person and or loss or damage to my personal property arising from, or in any way resulting from my participation in these activitiesTerms & Conditions• Programs and classes offered are subject to availability. • Spotlight DanceWorks Inc., at its own discretion, may withdraw or cancel a course without notice or liability other than to refund fees for lessons withdrawn or cancelled. We regret that we are unable to provide a refund for dance equipment and manuals. • There is a $20 charge for NSF cheques. • Spotlight DanceWorks Inc. reserves the right to suspend students for inappropriate conduct and/or non-payment of fees. • Students must comply with the class dress code and correct grooming as stated in the Studio Guidelines. • Students and Parents/Guardians are asked to acquaint themselves with our Studio Guidelines. Terms & Conditions * I declare having read and understand the above Informed Consent Agreement and the Terms and Conditions and hereby consent to participate acknowledging all the preceding. reCAPTCHA Submit
