Studio de danse Danielle Online Registration

Registration

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Merci d'avoir choisi le Studio de danse Danielle! SVP fournir l'information suivante pour les CAMPS et les COURS. Vous pourrez ensuite effectuer votre choix de camp et/ou de cours. Au plaisir de vous rencontrer bientot.............................................. Thank you for choosing Studio de Danse Danielle! Please provide the information below for CAMPS and CLASSES. You will then be able to choose the camp and/or class. We look forward to meeting you soon.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Parents

Nom de l'enfant/Child's Surname Last Name*

Where do you live?

Home Address*

City*

State/Prov*

Postal Code*

Home or Primary Phone*

Additional Info

En cas d'urgence/In case of emergency

Contact #1

Parent # 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

Contact #2

Parent # 2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Difficultes/Disabilites

Allergies (Leave blank if NONE)

Veuillez vous assurer de choisir le niveau et le groupe d'age approprie pour votre enfant. Si nous devons modifier votre inscription, nous entrerons en contact avec vous dans les plus brefs delais. Please ensure you choose the appropriate level and age group for your child. If we need to modify your class choice, we will contact you as soon as possible. NOUVEAU: CLIQUER "Select Class" POUR VOUS INSCRIRE AUX CAMPS. NEW: CLICK ON "Select Class" TO REGISTER FOR CAMPS.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Difficultes/Disabilites

Allergies (Leave blank if NONE)

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

Difficultes/Disabilites

Allergies (Leave blank if NONE)

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

Difficultes/Disabilites

Allergies (Leave blank if NONE)

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

Difficultes/Disabilites

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Acceptation des risques/ Assumption of Risk

Je donne, par la presente, mon consentement a ce que mon enfant, nomme ci-haut, participe aux cours. Je degage Studio de Danse Danielle et ses employes de tout blame et prestations advenant une (des) blessure(s), une perte ou des dommages subi(s) durant la participation a ces activites. J'en assume l'entiere responsabilite.

I hereby give my approval for the above mentioned child to participate in your classes. I assume all risks and hazards incidental to the participation and I do hereby waive the right to any and all claims arising out of an injury, a loss or any damage sustained on the premises or while participating in any activities involving Studio de Danse Danielle or any of its employees.