Registration
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Join CDL to celebrate Hallowe'en 2025 with a fun filled movie night for Tweens & Teens! Follow Us in Instagram to vote on your favourite Movie. Registration includes Popcorn & a Drink for the movie
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
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Aunt
Dancer
Father
Foster Parent
Grandparent
Guardian
Mother
Other
Parent
Sibling
Step-Parent
Uncle
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
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Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code:
*
Emergency Contact Info (Please enter someone other than Primary Contact)
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
homeschool
kindergarten
pre-K
preschool
university
Class Accommodations Needed (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
homeschool
kindergarten
pre-K
preschool
university
Class Accommodations Needed (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
homeschool
kindergarten
pre-K
preschool
university
Class Accommodations Needed (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
homeschool
kindergarten
pre-K
preschool
university
Class Accommodations Needed (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Other
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
homeschool
kindergarten
pre-K
preschool
university
Class Accommodations Needed (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Additional Information:
Liability Release
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As the legal parent or guardian, to the best of my knowledge the participant mentioned has no physical or medical concerns that may prevent participation either in class or online. To the best of my knowledge, all relevant medical, physical, emotional and cognitive concerns have been disclosed where it may impact learning, teaching or an otherwise positive experience for my child. Information received to the studio is confidential and will only be shared with those directly teaching or facilitating my child within studio activities. Connectivity instructors strive to provide the best learning environment possible. I am aware that at anytime I may speak with the director to ensure appropriate inclusion and learning strategies for my child are known and at minimum being attempted. I understand that in the event the studio is not able in its capacity to accommodate my child successfully in a particular program, that alternative solutions for program options will be at the discretion of the director. The studio will only be actively involved, or will only organize events that are deemed safe and inclusive according to guidance and safety measures as recommended by the Government of Alberta and Alberta Health Services. Medical Emergency: The undersigned gives permission to Connectivity Dance Ltd., it's owners, administrators, instructors and volunteers to seek medical treatment for the participant in the event they are not able to reach a parent or guardian or emergency contact on file. I have informed the director of any medical alerts or diagnosis that are relevant to urgent situations. I acknowledge the risks of partaking in physical activity and am aware that any resulting injury to the participant does not impact my obligation to pay any balance owing for the participant.
I've read the above and agree.
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