Clone of WORK IT Girl Program Registration Form (Fall 2023)

Student Registration Form - Mississauga

PLEASE FILL THE FOLLOWING INFORMATION FOR FALL 2023 TERM
SECTION A. STUDENT DETAILS
NewReturning
If new, how did you hear about us?
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
SECTION B. PARENT/GUARDIAN INFORMATION *** If you are a Returning Student and Parent/Guardian Information has NOT changed, skip to SECTION C.
Parent/Guardian Name:

First NameMiddle NameLast Name
Relation to Student:
Parent/Guardian Email:
example@example.com
Parent/Guardian Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SECTION C. EMERGENCY CONTACT & ADDITIONAL STUDENT INFO *** If you are a Returning Student and Emergency Contact Information has NOT changed, skip to SECTION D.
Secondary Emergency Contact Name (in case we can't get in touch with the parent/guardian filling out this form)

First NameMiddle NameLast Name
Relation to Student
Parent/Guardian Email #2
example@example.com
Parent/Guardian Phone #2
Student Years of Dance Experience
What are some of the most important leadership qualities you would like the student to learn in this program?
Please share with us any information that you would like us to know about your child:
SECTION D. PROGRAM REGISTRATION & WAIVER
Courses*
Please email info@janetco.live if you have questions about which level to enter. If a a program is cancelled due to low enrolment, registrants will be given one week notice and refunds will be issued subsequently.
WORK IT Girl Liability Waiver

Please read over the terms and conditions before signing this form.
I certify that my child is in good physical condition, and has not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems, which preclude his/her participation in this activity.
I understand that a 20% cancellation fee applies for cancellation within 1 week of class start date. Once the class starts, the program fee is 100% non-refundable. There are no makeup classes available for students that miss. Due to the progressive nature of the program, we encourage participants to attend as many classes possible to reap the full benefits of learning.
I give my voluntary consent for WORK IT Girl (Janet Co.) to photograph students for publications and all other marketing materials to be used for the sole purpose to promote the WORK IT Girl Program. I also understand that no royalty, special credit or other fees shall be made payable to me by reason of such use. Janet Co. will become the copyright owner of the Recording and I waive rights to privacy and compensation.
WORK IT Girl (Janet Co.) is not responsible for any damage or injuries that may occur while on the property or during the programs. Additionally Janet Co. is not responsible for any lost items on the property. I take responsibility for my child’s behaviour and any damage he/she may cause to the area while participating in the dance class.
Comments/Questions
Signature of Parent/Guardian (please sign in form with your cursor) *

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Date*
SECTION E. PAYMENT
Once your registration has been submitted by clicking the green button "Submit Application" below, you will be directed to the checkout page to make payment.

WORK IT Girl Fees:

New Location Mississauga Only Intro Special $249 + HST

(valid until September 22nd MIDNIGHT)

Once payment has been received and we have reviewed all your details, you will receive an email confirmation informing you that your child is officially in the WORK IT Girl program.
Should be Empty:

Student Registration Form - Mississauga

SECTION A. STUDENT DETAILS

SECTION B. PARENT/GUARDIAN INFORMATION *** If you are a Returning Student and Parent/Guardian Information has NOT changed, skip to SECTION C.

SECTION C. EMERGENCY CONTACT & ADDITIONAL STUDENT INFO *** If you are a Returning Student and Emergency Contact Information has NOT changed, skip to SECTION D.

SECTION D. PROGRAM REGISTRATION & WAIVER

WORK IT Girl Liability Waiver

SECTION E. PAYMENT