Karin Hobby Dance Academy Printable Registration Form  Home

  Karin Hobby Dance Academy   1490 Richmond Street  N London ON N6G 2M3 Ph5198506666

Fax 519-434-0714

KHDANCE   Registration Online Form 2017

Student Name: ___________________________________________ Date of Birth____________________ Age_____

Mother: ___________________________________________ Father________________________________________


_________________________________City  ___________________Prov ________Postal code_________________________  

Phone (Home) _____________________________ Work _____________________Cell_________________________


Allergies / Medical / Learning Issues: _________________________________________________________________ 

Classes: Type/Level/Day/Time:  1______________________________  2 _____________________________________

How did you hear about us? __________________________________________________________________________

Registration secures a space in class. Tuition payable by cash or cheque to Karin Hobby Dance Academy or by credit card including 13% HST. Deposit ($100) and registration fees are non refundable and there may be an administration fee for transferring between classes. Term fees are non refundable once the term has started. Cheques for the initial payment cannot be post-dated. There is a $25 fee for returned cheques. Transfers will only be permitted when space and level of training allows. Please read the handbook for full details. Please do not email your credit card information.

If paying in full:   If paying in 2 instalments:    
Full term fees: $ ________   First Instalment     $ ________ Second    $ _________
Registration fee $       25.00  Registration Fee  $       25.00 (cheque dated Dec 1)  
Subtotal $ ________  Subtotal  $ ________    
Add 13% HST $ ________  Add 13% HST  $ ________   Add 13% HST   $ _________
Total  $ ________  Total  $ ________   Total      $ _________
Cheque Number  ________   Cheque Number  ________ Cheque Number   _________

 If paying by credit card indicate    M/C        Visa        

Full name on the credit card _____________________________________________________________________

Number_________________________________________________________ Expiry mo/yr___________________

Signature________________________________________________________ Date __________________________

Waiver Agreement.
I understand that there will be costume fees for  end of year shows. In addition, I have read the student/parent handbook and agree to the conditions outlined therein. I hereby consent to my child being photographed and or videotaped in school performances by photographers assigned by the school. These photographs may be used for KHDANCE promotional displays, advertising and school related functions. I respect that my own photographing of other KHDANCE students is not permitted without their own consent both in class and in performance. Video recording or other   recording of KHDANCE performances are not permitted due to copyright laws. I acknowledge that dance is a physical activity and the potential risk for physical injury does exist. Our goal is to minimise this risk. Acknowledging this, I will not hold KHDANCE, its faculty, staff, volunteers or venues responsible for any injuries which do occur. I understand that failure to abide by the conditions of enrolment may result in discontinuation of studies at KHDANCE and forfeiture of the remainder of paid tuition. I understand that in providing my email contact  I consent to receiving school communications to the address provided. I understand that students are generally not accepted if studying or teaching at other dance schools within the city and non disclosure will constitute a breach of school policy. Any concerns I have will be brought forward to school staff.  Positive feedback is also welcome!

Parent/Guardian Signature________________________________________ Date ______________________________________

Welcome to Karin Hobby Dance Academy ©KHDANCE2017 We look forward to working with you!
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