Hip-Hop Registration Form
Dance for Newcomers is on Wednesdays from 4-5pm at the Commonwealth Recreation Centre. The class is West African Dance and it will start January 18th and run until March 1st with the instructor Eric Awuah.
Name, DOB, gender, resident status, and PR/UCI # of participants. Press the + sign to add more than 1 family member.
*
Date of Arrival in Canada
*
-
Month
-
Day
Year
Date
Country of Origin
*
What is your native language?
*
Please Select
Ahmaric
Arabic
Dari
English
Chinese
Farsi
French
Hindi
Oromo
Pashto
Punjabi
Tagalog
Tigrinya
Somali
Vietnamese
Urdu
Other
Do you speak any other languages other than your native language and English?
*
Yes
No
What other languages do you speak?
*
Preferred official language
*
English
French
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Do you consider yourself as Indigenous?
*
Yes
No
Do not wish to answer
Which Dance class do you want to join?
Hip Hop for Newcomers (Oct. 26th-Dec. 7th)
West African Dance (Jan. 18th-March 1st)
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Permissions
Consent (Consent should be made by the parent/guardian If the participant is under 18 years old)
Protecting Personal Information
AHC is committed to safeguarding the personal information provided by our clients. The personal information that you provide is collected for AHC purposes such as; activity enrolment, emergency contacts, AHC program assessment, funding reports and quality enhancement. Your collected information is not intended to be shared outside AHC without first obtaining your consent, unless obliged or permitted by law to disclose it. AHC keeps your information confidential, your information will be treated with the utmost care and discarded appropriately.
Photography & Media release
Photography & Media Release: I hereby give permission for me/my child/my projects/my child’s projects to be photographed/filmed by Action for Healthy Communities. I understand the photos/films will be used for promotion, public presentations, sharing purposes and/or reports to our donors and for promotional purposes including flyers, brochures, newspapers, websites, and social media. I understand that although my child’s photograph/film/projects may be used for advertising, I do not expect compensation and that all photos/film/projects are the property of AHC and its partners.
Consent (Consent should be made by the parent/guardian IF the participant is under 18 years old)
*
I give consent
I do not give consent
Informed consent and waiver
I acknowledge that I am aware of, and accept the inherent physical risks and the other possible risks, dangers, and hazards associated with being a participant. These risks include but are not limited to all manner of injuries, broken, damaged or lost belongings and transmission of diseases (including Covid-19) in various ways and types from contact with other participants. I understand that Action for Healthy Communities (AHC) (employees, facilitators, and volunteers) are not responsible for any injury, loss or damage of any kind sustained by participants during the program or after the program day has ended. For any youth that have wristbands to continue at the recreation centres after the program time has ended, I understand that AHC will no longer be responsible for their care or their actions and they will be expected to follow the recreation centre rules and regulations as mandated by the centre. I understand that the rules and regulations are designed for the safety and protection of participants and hereby agree to follow /inform (my child) of the importance of abiding by the rules and regulations set down by Action for Healthy Communities.
Signature
By signing this I declare that I've carefully read, understood and agreed to the contents of the above (The form should be signed by parent or guardian of the youth if the youth are under 18 years old).
*
Parent/Guardian's name (for youth under 18 years old).
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