Class Registration Form 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 * Family Discount, $10 for each additional child. *Pointe classes are not subject to discount.Student InformationStudent First NameStudent Middle NameStudent Last NameDate of Birth* DD MM YYYY Age*Medical ConditionsAllergiesClass InformationAll class and level selections below will be reviewed and confirmed with parents.Class 1Please Select Dance Class and LevelCreative Dance W-1 (3 yrs)Creative Dance W-2 (4-5 yrs)Creative Dance TH-1 (3.5-5 yrs)Creative Dance 1 (5 yrs)Creative Dance 2 (6 yrs)Creative Dance 3 / Pre-JazzCreative 4 / Hip Hop 1 (8yrs)Ballet 1-2 (6-7yrs)Ballet 3-4Ballet 5Ballet 6-7Ballet 8-9Ballet 10-11Ballet 12Pointe BasicPointe 4Acro 1 (7-9yrs)Acro 2 (9-11yrs)Acro 3 (11-14 yrs)Jazz 2-3Jazz 4-5Jazz/Lyrical 6-7Jazz/Lyrical 8-9-10Jazz/Lyrical 11-12Jazz/Lyrical/Contemporary 13Contemporary University Students/adultTap 4-5-6Teen TapAdvanced TapStep Dance 1-2Step 3Step Dance IntermediateStep Dance AdvancedHip Hop 2-3Hip Hop 4-5Hip Hop 6-7Hip Hop 8-9-10Hip Hop 11Fee #1:Class 2Please Select Dance Class and LevelCreative Dance W-1 (3 yrs)Creative Dance W-2 (4-5 yrs)Creative Dance TH-1 (3.5-5 yrs)Creative Dance 1 (5 yrs)Creative Dance 2 (6 yrs)Creative Dance 3 / Pre-JazzCreative 4 / Hip Hop 1 (8yrs)Ballet 1-2 (6-7yrs)Ballet 3-4Ballet 5Ballet 6-7Ballet 8-9Ballet 10-11Ballet 12Pointe BasicPointe 4Acro 1 (7-9yrs)Acro 2 (9-11yrs)Acro 3 (11-14 yrs)Jazz 2-3Jazz 4-5Jazz/Lyrical 6-7Jazz/Lyrical 8-9-10Jazz/Lyrical 11-12Jazz/Lyrical/Contemporary 13Contemporary University Students/adultTap 4-5-6Teen TapAdvanced TapStep Dance 1-2Step 3Step Dance IntermediateStep Dance AdvancedHip Hop 2-3Hip Hop 4-5Hip Hop 6-7Hip Hop 8-9-10Hip Hop 11Fee #2Class 3Please Select Dance Class and LevelCreative Dance W-1 (3 yrs)Creative Dance W-2 (4-5 yrs)Creative Dance TH-1 (3.5-5 yrs)Creative Dance 1 (5 yrs)Creative Dance 2 (6 yrs)Creative Dance 3 / Pre-JazzCreative 4 / Hip Hop 1 (8yrs)Ballet 1-2 (6-7yrs)Ballet 3-4Ballet 5Ballet 6-7Ballet 8-9Ballet 10-11Ballet 12Pointe BasicPointe 4Acro 1 (7-9yrs)Acro 2 (9-11yrs)Acro 3 (11-14 yrs)Jazz 2-3Jazz 4-5Jazz/Lyrical 6-7Jazz/Lyrical 8-9-10Jazz/Lyrical 11-12Jazz/Lyrical/Contemporary 13Contemporary University Students/adultTap 4-5-6Teen TapAdvanced TapStep Dance 1-2Step 3Step Dance IntermediateStep Dance AdvancedHip Hop 2-3Hip Hop 4-5Hip Hop 6-7Hip Hop 8-9-10Hip Hop 11Fee #3Class 4Please Select Dance Class and LevelCreative Dance W-1 (3 yrs)Creative Dance W-2 (4-5 yrs)Creative Dance TH-1 (3.5-5 yrs)Creative Dance 1 (5 yrs)Creative Dance 2 (6 yrs)Creative Dance 3 / Pre-JazzCreative 4 / Hip Hop 1 (8yrs)Ballet 1-2 (6-7yrs)Ballet 3-4Ballet 5Ballet 6-7Ballet 8-9Ballet 10-11Ballet 12Pointe BasicPointe 4Acro 1 (7-9yrs)Acro 2 (9-11yrs)Acro 3 (11-14 yrs)Jazz 2-3Jazz 4-5Jazz/Lyrical 6-7Jazz/Lyrical 8-9-10Jazz/Lyrical 11-12Jazz/Lyrical/Contemporary 13Contemporary University Students/adultTap 4-5-6Teen TapAdvanced TapStep Dance 1-2Step 3Step Dance IntermediateStep Dance AdvancedHip Hop 2-3Hip Hop 4-5Hip Hop 6-7Hip Hop 8-9-10Hip Hop 11Fee #4Class 5Please Select Dance Class and LevelCreative Dance W-1 (3 yrs)Creative Dance W-2 (4-5 yrs)Creative Dance TH-1 (3.5-5 yrs)Creative Dance 1 (5 yrs)Creative Dance 2 (6 yrs)Creative Dance 3 / Pre-JazzCreative 4 / Hip Hop 1 (8yrs)Ballet 1-2 (6-7yrs)Ballet 3-4Ballet 5Ballet 6-7Ballet 8-9Ballet 10-11Ballet 12Pointe BasicPointe 4Acro 1 (7-9yrs)Acro 2 (9-11yrs)Acro 3 (11-14 yrs)Jazz 2-3Jazz 4-5Jazz/Lyrical 6-7Jazz/Lyrical 8-9-10Jazz/Lyrical 11-12Jazz/Lyrical/Contemporary 13Contemporary University Students/adultTap 4-5-6Teen TapAdvanced TapStep Dance 1-2Step 3Step Dance IntermediateStep Dance AdvancedHip Hop 2-3Hip Hop 4-5Hip Hop 6-7Hip Hop 8-9-10Hip Hop 11Fee #5Class 6Please Select Dance Class and LevelCreative Dance W-1 (3 yrs)Creative Dance W-2 (4-5 yrs)Creative Dance TH-1 (3.5-5 yrs)Creative Dance 1 (5 yrs)Creative Dance 2 (6 yrs)Creative Dance 3 / Pre-JazzCreative 4 / Hip Hop 1 (8yrs)Ballet 1-2 (6-7yrs)Ballet 3-4Ballet 5Ballet 6-7Ballet 8-9Ballet 10-11Ballet 12Pointe BasicPointe 4Acro 1 (7-9yrs)Acro 2 (9-11yrs)Acro 3 (11-14 yrs)Jazz 2-3Jazz 4-5Jazz/Lyrical 6-7Jazz/Lyrical 8-9-10Jazz/Lyrical 11-12Jazz/Lyrical/Contemporary 13Contemporary University Students/adultTap 4-5-6Teen TapAdvanced TapStep Dance 1-2Step 3Step Dance IntermediateStep Dance AdvancedHip Hop 2-3Hip Hop 4-5Hip Hop 6-7Hip Hop 8-9-10Hip Hop 11Fee #6Class 7Please Select Dance Class and LevelCreative Dance W-1 (3 yrs)Creative Dance W-2 (4-5 yrs)Creative Dance TH-1 (3.5-5 yrs)Creative Dance 1 (5 yrs)Creative Dance 2 (6 yrs)Creative Dance 3 / Pre-JazzCreative 4 / Hip Hop 1 (8yrs)Ballet 1-2 (6-7yrs)Ballet 3-4Ballet 5Ballet 6-7Ballet 8-9Ballet 10-11Ballet 12Pointe BasicPointe 4Acro 1 (7-9yrs)Acro 2 (9-11yrs)Acro 3 (11-14 yrs)Jazz 2-3Jazz 4-5Jazz/Lyrical 6-7Jazz/Lyrical 8-9-10Jazz/Lyrical 11-12Jazz/Lyrical/Contemporary 13Contemporary University Students/adultTap 4-5-6Teen TapAdvanced TapStep Dance 1-2Step 3Step Dance IntermediateStep Dance AdvancedHip Hop 2-3Hip Hop 4-5Hip Hop 6-7Hip Hop 8-9-10Hip Hop 11Fee #7Total Of All FeesAdditonal CommentsParent 1This parent will receive confirmation of placement in classes and fees.Parent 1 First NameParent 1 Last NameParent 1 Address Street Address City State / Province / Region ZIP / Postal Code Parent 1 Home PhoneParent 1 Mobile PhoneParent 1 Email Parent 2Parent 2 First NameParent 2 Last NameParent 2 Address Street Address City State / Province / Region ZIP / Postal Code Parent 2 Home PhoneParent 2 Mobile PhoneParent 2 Email Disclaimer & LiabilityPermission* 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. Accident, Illness & Injury* I understand that ACDA and any of its officers, staff or instructors cannot be held liable and responsible for injury or illness, including Covid-19 while participating in ACDA classes or events. I understand that any student or teacher experiencing Covid-19 symptoms as outlined at the website listed below should stay home, and will not be permitted to attend class. Anyone who developes symptoms during class will be isolated and parents notified immediately. Please click here to see a complete list of COVID-19 SymptomsLiability* 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.*YesNoStudent's Name*Parent/Guardian*Date* Date Format: DD slash MM slash YYYY Payment InformationThe 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: antigonishdance@gmail.comParent To Receive Tax Receipt:Parent 1Parent 2EmailThis field is for validation purposes and should be left unchanged.