Student Registration Form
Please fill out the form carefully for registration
Student Name
*
First Name
Middle Name
Last Name
Parent/ Guardian Name
*
First Name
Middle Name
Last Name
Student Birth Date
*
January
February
March
April
May
June
July
August
September
October
November
December
Month
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Day
2022
2021
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1925
1924
1923
1922
1921
1920
Year
Student Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian E-mail
*
example@example.com
Mobile Number
*
Phone Number
Work Number
Please select your program ( see program breakdown under classes/schedule)
Please Select
Pre Competitive
Part-Time
Full Time
Elite
Senior Competitive Program
Studio Waiver, Policies, Procedures, Covid-19 Protocols
I/we realize that participation in dance classes and activities could result in some possible personal injury. Despite precautions being taken by the studio, accidents and injuries may occur. By signing this release form, I/we (the dancer and parent/guardian) assume all risks related to the use of any and all spaces used by Pure Dance Crew. Additionally, by signing into our virtual dance classes via zoom, you are relieving any and all liability from Pure Dance Crew, it's staff, instructors, facility and any association with. I/we agree to release from responsibility the Pure Dance Crew Studio, including all guest teachers, dancers, staff members, and facilities used by both entities from any cause of action, claims, or demands now and in the future. I/we will not hold Pure Dance Crew and its staff, liable for any personal injury including: scrapes, bruises, cuts, sprains, fractures, broken bones, concussions or death or any personal property damage/loss, which may occur on the premises before, during or after classes. CONFIRMATION: BY SIGNING BELOW, I ACCEPT AND INDICATE THAT I AM RESERVING CLASSES BASED OFF THE SELECTION ABOVE. I UNDERSTAND THAT WITHOUT PAYMENT, REGISTRATION IS NOT COMPLETED AND UNTIL AN INVOICE HAS BEEN RECEIVED AND PAID, REGISTRATION WILL NOT BE FINALIZED. BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE THUS AGREEING TO THE ABOVE TERMS AND CONDITIONS, AS WELL THE TERMS AND CONDITIONS THAT APPLY TO EACH PROGRAM OFFERED. A $25.00 non refundable administrative deposit will be due upon registration to secure your spot in the class(es). Failure to provide payment will result in loss of reservation of classes.
Signature
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Registration Fee
Register and secure your spot with the Crew for the 2021/2022 dance season. All registration fees must be paid in full in order to secure enrollment.
$
25.00
CAD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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