Dance Registration Form 2016-17

Personal Information: Dancer’s First Name: Click to enter text. Dancer’s Last Name: Click to enter text. Address: Click to enter text. Postal Code: Click to enter text. Home Phone No: Click to enter text. Birth date MM-DD-YYY. Gender: male/female Mother's/Guardian's name: Click to enter text. Work Ph# Click to enter #. Cell # Click to enter #. Father's/Guardian's name: Click to enter text. Work Ph# Click to enter #. Cell # Click to enter #. Best contact email: Click to enter text. Allergies or medical: Click to enter text.

Classes Requested* (Please refer to the schedule and fill in the class type, date, and time) Class Type Level Class Day Time Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text Click to enter text *Note: many classes require testing for placement. Placement of students will ultimately be decided by the studio Directors. Placement is dependent upon class size, availability and dance ability. Class spots will be filled on a first come first serve basis. Maples Academy of Dance reserves the right to cancel any classes due to lack of enrolment. Class placement will not be finalized until testing is complete (if required) and payment is received and processed – Payment must be made by cash or cheque in the studio.

Payment (This Section to be completed by MAD Staff): Class(s) Price: $monthly fee Family Discount (5%): $discount Multi-Class Discount (5%): $discount $25.00 Registration Fee (per dancer, non-refundable): $reg fee $65.00 Costume Deposit (per class, non-refundable after December 1, 2016) $65.00 x # (classes) =$fee Total Annual fee: $total annual fee Payment Options 1) Full Payment - Class Price x 10 months plus costume fees: $total annual fee 2) Term Payment (Two Post-Dated Cheques): September 1, 2016 Payment (4 months of classes, plus Registration Fee & Costume Deposits): $term 1 fee January 1, 2017 Payment (6 months of classes): $term 2 fee 3) Monthly Payment (Post Dated Cheques, dated first of each month from September to June, or cash due on the first of each month, September to June): Month 1 = September 1, 2016 (monthly fee plus Registration Fee & Costume Deposits): $September fee Months 2-10/October 2016-June 2017 (monthly fee): $ monthly fee Oct-June Additional Fees: NSF Cheques: There will be a $25.00 administration fee for all NSF Cheques Monthly Late Fee: $5.00 per month

SIGNATURE By electronically typing my name below, I declare I have read and understood the above information and information on two of this form and agree to its contents. Date: Click to enter date Parent/Guardian name: Click to sign name

Registration Processed by MAD Staff: staff Costume Fee: Costumes are required for the Year-End Recital. A $65.00 Costume Deposit Fee per class is due upon registration. Should your child`s costume cost more than the Costume Deposit, you will be notified and invoiced for the balance. Cost doesn’t include dance tights or shoes. No Costume Deposit refunds will be provided for students who withdraw after December 1, 2016. Failure to provide the Costume Deposit will result in the dancer not receiving a costume. YES - Parent/Guardian Initial Click here to initial

Email Consent: By providing us with your email address, you are consenting to receiving electronic communications from Maples Academy of Dance, so that we can provide you with information and updates regarding our dance studio’s programming and services, and other related information that may be of interest, relevance or importance to you/your child’s involvement in our programs. If not provided directly via our studio email address at [email protected] this information will be provided via Mail Chimp, or another messaging system of similar nature. You can withdraw this consent at any time either in writing to Maples Academy of Dance at 40 Mandalay Drive or via email to [email protected], by phone at 204-697-9205, or by clicking unsubscribe in any email communications.

YES - Parent/Guardian Initial Click here to initial

Photographs/Video/ Website/Publicity: I agree that my child's name and picture may be used for promotional materials, including printed and website material, and that my child may be video-taped at the year-end recital.

YES - Parent/Guardian Initial Click here to initial

Waiver: I acknowledge that certain risks of injury are inherent to participation in dance. These types of injuries may be minor or serious and may result from one’s actions, or the actions or inactions of others or a combination of both. I understand that certain activities require a minimum level of fitness and health (physical, mental and emotional) and that each person has a different capacity for participating in these activities. Some activities involve an intense level of activity. I agree that Maples Academy of Dance, its staff and agents shall not be liable for any injury, loss or damage to person or property, incurred during this program, including deterioration of health or illness or aggravation of any pre- existing condition resulting from participation in these activities, property damage or lost property.

YES - Parent/Guardian Initial Click here to initial

Class Withdrawal: Dancers who wish to withdraw from class must provide written notification to Maples Academy of Dance. Refunds for those having made full or term payments will be based on the number of full months remaining less discounts. It is understood and agreed that should the dancer withdraw from class(es) after January 1, 2017, no refund will be given, except for medical reasons (medical note required).

YES - Parent/Guardian Initial Click here to initial

Expectations: Proper dancewear is necessary to ensure the dancer gets the most out of class and to prevent injury. Dancers are required to come to class in the appropriate footwear, tights, body suit and hair (See Dress Code). It is understood and agreed that the Dress Code will be strictly enforced, and failure to come to class appropriately dressed may result in the dancer being removed from class. In order for each dancer to reach their full potential, respect is essential, and we need both dancers‘ and parents' cooperation and good behaviour. Any parent or student acting in a disrespectful manner, or creating conflicts or making derogatory comments towards other parents, students, teachers, or other dance studios and dancers, will be strictly dealt with, and may result in the student being removed from class permanently (see Rules and Code of Conduct).

YES - Parent/Guardian Initial Click hereto initial