hidden reg – Antigonish Creative Dance Association

Please be sure to double-check your information for typos (particularly your contact information) and please refrain from using all capital letters. Thank you.

Student 1

Last Name First Name Middle Name Date of Birth Allergies: Medical conditions we should be aware of:

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.

Dance Type and Level Level to be reviewed and confirmed	First Class Fee	Discounted Class Fee(s)







Total:

Parent 1 (Will receive placement confirmation)

Last Name First Name Street number & Name City/town Province City/town Home Phone Cell Phone Email

Parent 2

Last Name First Name Street number & Name City/town Province City/town Home Phone Cell Phone 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.

Participant's Name: Parent / Guardian Name: Date:

Payment

The preferred method of payment for the fall term is E- Money 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, 2017 and providing the balance by E-transfer no later than April 1st, 2017.

If you require an alternate method of payment or need additional information, please contact Sally Clark: sclark@stfx.ca

Select Parent to receive tax receipt: