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________________________________________
Address__________________________________________________________________________________________
_________________________________City
___________________Prov
________Postal code_________________________
Phone (Home) _____________________________
Work
_____________________Cell_________________________
Email____________________________________________________________________________________________
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!
Better Ballet
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