2021-2022 competitive registration form

Student Name *

First Name Middle Name Last Name

Parent/ Guardian Name *

First Name Middle Name Last Name

Student Birth Date *

Month Day Year

Student Gender *

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)

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. &#13;&#10;&#13;&#10;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.&#13;&#10;&#13;&#10;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. &#13;&#10;&#13;&#10;CONFIRMATION:&#13;&#10;&#13;&#10;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. &#13;&#10;&#13;&#10;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.&#13;&#10;&#13;&#10;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

Enter coupon

Subtotal

$ 0.00 CAD

Tax

$ 0.00 CAD

Total

$ 0.00 CAD

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Student Registration Form