Kristy's Dance Fusion Online Registration

Registration

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Kristy's Dance Fusion Inc. - Registration Form | Return to Main Website

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Province*

Postal Code*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Sask Health Number*

Contact #1

Parent Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Parent Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School Grade*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please select your classes now:

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School Grade*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please select your classes now:

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School Grade*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please select your classes now:

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School Grade*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please select your classes now:

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School Grade*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Please select your classes now:

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Release of Liability

As the legal parent or guardian, I release and hold harmless Kristy's Dance Fusion Inc., its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Kristy's Dance Fusion Inc., its owners and operators or in route to or from any of said premises. I will not hold Kristy's Dance Fusion liable for any injuries sustained while taking online Zoom classes at home.

I've read the above and agree.

Medical Emergencies

The undersigned gives permission to Kristy's Dance Fusion Inc., its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condtions and/or declare the participant to be in good physical and mental health. I request that our doctor/physician be called and that my child be transported to the hospital.

I've read the above and agree.

Canada's Anti-Spam Laws

At this time there is implied consent that by providing my email address, I agree to allow Kristy's Dance Fusion Inc. to send me emails with information pertaining to my child's dance classes and important upcoming information about Kristy's Dance Fusion Inc. in general.

By checking this box, I am giving direct consent to allow Kristy's Dance Fusion Inc. to send me emails with information pertaining to my child's dance classes and/or important upcoming information about Kristy's Dance Fusion Inc. in general.

It is understood that my email address will not be distributed to other 3rd parties and will only be used for communication purposes between myself and Kristy's Dance Fusion Inc. I may withdraw consent at any time.

I've read the above and agree.

Payment Policies

For Zoom classes in May 2020: Tuition must be paid in the form of credit card payment through Jackrabbit account or by e-transfer to kdancefusion@gmail.com. Any credits for April and May 2020 tuition will be applied to Zoom class tuition at the client's request.

Regular season (September-May): Tuition payment options: Credit Card (Visa, M/C) or monthly post dated cheques.
For credit card payments there are two payment options: full year payment (with a 2% discount) or tuition will be pushed to the credit card for 3 months dance tuition at a time (Sept-Nov) (Dec-Feb) (Mar-May). Monthly tuition is mandatory until the studio has received a written request of cancellation. Any attendance during a month constitutes a full month's tuition. We require one month's notice of cancellation of classes.

A registration fee of $30.00 + GST per family is due and payable at the time of registration and is non-refundable.

A costume deposit of $50.00 per class is due and payable at the time of registration but the cheque may be post dated for October 1, 2019. This deposit will be subtracted from your costume invoice that is sent out when the costumes arrive for our year end dance showcase and/or competitions. The costume deposit becomes non-refundable by October 31, 2019.

All dance tuition is subject to 5% GST. Costume DEPOSITS will not be taxed at the time they are collected. Costumes will be subject to 11% TAX (5% GST and 6% PST).

Tuition is due on the 1st of the month. Late fees will be applied after the 10th of the month if tuition has not been paid.

I've read the above and agree.

Signature Text

As the legal parent or guardian, I release and hold harmless Kristy's Dance Fusion Inc., its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Kristy's Dance Fusion Inc., its owners and operators or in route to or from any of said premises.

I agree to allow Kristy's Dance Fusion Inc. to use my credit card on file for outstanding amounts owing.

I, the undersigned, on behalf of the parties registered, authorize Kristy's Dance Fusion Inc., use of any photographs and/or videos as well as printing of names for advertising, promotional, and publicity purposes.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

Payment Schedule*

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

Country

City

Province

Postal Code