Registration for fall classes and Summer Programs are now being accepted!! Register online to reserve placement. Please do not delay as classes are filling up quickly! Online Registration Form: Please register online to reserve placement for any of our programsInstructions Please complete the following form. You can select one or more classes. For Summer Programs please go to the lower portion of the form. This will reserve your spot in our class(es), and someone from our office will contact regarding payment. Thank you for registering and welcome to the Dance Academy of Prince Rupert!Contact Information:Complete Your Information: Please complete all required informationDate Email *Secondary or Student Email Secondary or Student Email Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabwePhone *Cell Phone About the DancerFirst and Last Name of Dancer *Date of Birth (Month/Day/Year) *Gender FemaleMaleGuardian (1) Full Name *Guardian (2) Full Name Medical Conditions or Special Needs Please list any allergies, medical conditions or special needs the Studio should be aware of.School Please check the school the dancers attendsPre-School MorningsPre-School AfternoonsAnnunciationConradLax KleenPineridgeRooseveltPrince Rupert Middle SchoolCharles Hays Secondary SchoolOtherNew to Dance Academy? How did you hear about us? Please check one or more boxesWord of Mouth ( friends/family)NewspaperLocation/ SignageSocial Media (ie Facebook, Instagram)Online (Web Page)PosterRecital or other community performancesReferral If you were referred by a current Dance Academy Client please state their name HERE so that they may receive their REFERRAL DISCOUNTClass Information for regular season classes:Program Choice Please Check OneRecreational ProgramCompetitive Program ( DAPR Team)2017-2018 Regular Season Classes Check one or more classes.Acrobatics (ages 6 & up)Ballet (ages - 6 & up)Boys Only Tumbling (ages 4-7)Hip Hop (ages 6 & up)Jazz (ages 6 & up)Modern (ages 10 & up)Pre-Ballet (ages 5-6)Pre-Jazz (ages 5-6)Rhythm & Dance (pre-school dance ages 3-4)Song & Dance (ages 6 & Up)Tap (ages 5 & up)I am unsure about class selection. Please contact me by telephone so that all options can be explained to me in personFREE TRIAL CLASS! Please check the above class your child would like to tryDAPR 8 Week Classes Fall 2017 Adult JazzAdditional Information, Questions or ConcernsAdditional Information Please use this space to inform us of any additional information regarding your dancer or to address any questions or concerns regarding registration or classes. We will contact you with a response as soon as possible:)Liability and ReleaseLiability and Release *Liability: The Dance Academy of Prince Rupert, its’ proprietor, or those in its’ employ are not liable for any injury, sickness or disability which occurs due to the physical activity of dance; any loss of or damage to personal property, whether it be at the studio, competition, event or travel. I exempt, release and indemnify the Dance Academy of Prince Rupert and any and all persons related to the Dance Academy of Prince Rupert from any and all liability claims, demands, or causes of action whatsoever from any damage, loss or physical injury to myself or my participating minor child. Release of Information: I hereby give the Dance Academy of Prince Rupert permission to release my personal contact details to staff and parent volunteers for the purpose of contacting me regarding my participation in the Dance Academy of Prince Rupert. Voluntary termination: One month’s written notice is required. One month from the receipt of the letter will be charged as an administration fee, the remaining tuition will be returned to you. It is the students choice if they wish to finish out the month after their notification. If a class is cancelled by the Academy a full refund of the remaining tuition, will be issued. Costume deposits will not be refunded after October 31st Tuition: Tuition fees can be paid in 1, 3 or 10 payments by cheque, Visa, and/or Mastercard. Please note – Cash or debit must be paid in 3 term payments. The 10 payment option is an equal divide of fees, not a monthly fee, and does not correspond to how many classes are in a month. If tuition fees are not paid when due the student will be removed from classes until the account is settled. For emergencies, please contact the bookkeeper so arrangements can be made. All costume deposits are due at registration. There is a $25 charge for returned cheques. Interest will be charged on overdue accounts. If the student’s surname is different from the surname on the cheque please write the student’s name in the memo section on the cheque. I AGREE AND ACCEPT THESE TERMSAgree VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
