Class Registration Form – Antigonish Creative Dance Association

Welcome to our class registration form! Please be sure to double-check your information for typos (particularly your contact information) and please refrain from using all capital letters. Thank you for your help in providing an accurate application.

Fee Information
First class listed must be the highest priced class as listed on the class schedule. For additional class fees please see the schedule.

Family Discount *
Second Child - Deduct $15 from tuition
Third Child - Deduct $25 from tuition

*Pointe classes are not subject to discount.
Student Information
Student First Name
Student Middle Name
Student Last Name
Date of Birth*

DD
MM
YYYY
Age*
Medical Conditions
Allergies
Class Information
All class and level selections below will be reviewed and confirmed with parents.
Class 1
Fee #1:
Class 2
Fee #2
Class 3
Fee #3
Class 4
Fee #4
Class 5
Fee #5
Class 6
Fee #6
Class 7
Fee #7
Total Of All Fees
Additonal Comments
Parent 1
This parent will receive confirmation of placement in classes and fees.
Parent 1 First Name
Parent 1 Last Name
Parent 1 Address
Street Address City State / Province / Region ZIP / Postal Code
Parent 1 Home Phone
Parent 1 Mobile Phone
Parent 1 Email
Parent 2
Parent 2 First Name
Parent 2 Last Name
Parent 2 Address
Street Address City State / Province / Region ZIP / Postal Code
Parent 2 Home Phone
Parent 2 Mobile Phone
Parent 2 Email
Disclaimer & Liability
Permission*
- I hereby give ACDA permission to use any photographs/videos taken of my child in this program for future promotional activities.
Anti-spam*
- Please note that due to Canada's anti-spam law, we require your express consent in order continue to send you news about our school and shows. I hereby give consent to be added to ACDA e-mail list and to receive notices approximately 6 times per year.
Accidents & Injury*
- In case of injury or accident of any kind while participating in ACDA programming, ACDA, any employee or volunteer of ACDA, will not be held liable for that occurrence. I hereby release ACDA, its employees or volunteers from all claims or damage, which may arise out of any loss or personal injury to the named participant in this program.
Liability*
- Dancing is a strenuous activity from which injuries could arise. Each student may decline to participate in any activity. Please inform the instructor of any physical limitations the student may have.
I understand that checking the above boxes constitutes a legal signature confirming that I acknowledge and agree to the above terms.*
Student's Name*
Parent/Guardian*
Date*
Date Format: DD slash MM slash YYYY
Payment Information
The preferred method of payment for the fall term is e-transfer and after course selection has been approved, Parent 1 as listed above will receive an email with payment instructions. Fees exceeding $200 may be paid in two installments by paying minimum $200 by February 1st and providing the balance by e-transfer no later than April 1st. If you require an alternate method of payment or need additional information, please contact Sally Clark: sclark@stfx.ca
Parent To Receive Tax Receipt:
Comments
This field is for validation purposes and should be left unchanged.

Fee Information

Family Discount *

Student Information

Class Information

Parent 1

Parent 2

Disclaimer & Liability

Payment Information