2020-21 Boys Can Dance Registration | Victoria Academy of Ballet

SESSIONAL CLASS REGISTRATION

STUDENT CONTACT INFORMATION:

Student Name:*

First

Last

Gender*

Female

Male

Date of Birth: *

day

/

month

/

year

Age*

Student Email:

Student Phone:

Academic school student is attending:*

PRIMARY PARENT/GUARDIAN CONTACT INFORMATION:

Primary Parent/Guardian Name:*

First

Last

Primary Parent/Guardian Address:*

Street Address City State / Province / Region Postal / Zip Code Country

Primary Parent/Guardian Home Phone:

Area Code

-

Phone Number

Primary Parent/Guardian Cell Phone:*

Area Code

-

Phone Number

Primary Parent/Guardian Email:*

SECONDARY PARENT/GUARDIAN EMAIL:

Secondary Parent Name:

First

Last

Secondary Parent Address:

Street Address City State / Province / Region Postal / Zip Code Country

Secondary Parent E-mail:

Secondary Parent Phone:

PROGRAM SELECTION:

Program Selection:*

Teen Ballet

Boys Can Dance

PAYMENT INFORMATION:

Payment made in a lump sum by: Cheque or Paypal

Tuition is due in full at the time of registration. You are not fully registered until payment has been set in place.

Please contact the office if you have any questions

Payment Method Requested:*

Cheque

Paypal (Online Debit, Credit, or PayPal account)

Discounts:

Sibling Discount (multiple siblings enrolled) - 10% off sibling with lesser tution amount

Name of Sibling:

First

Last

MEDICAL AUTHORIZATION:

Medical Conditions and Allergies:

Current Medications:

Musculoskeletal Injuries (Past or Present):

I have chosen to vaccinate my child:*

Yes

No

MEDICAL INSURANCE IS MANDATORY IN CANADA and mandatory for participation in Victoria Academy of Ballet (“VAB”) programs. Participants in VAB programs, or their guardians, must assume the risk of injury associated with participation in rigorous physical activity programs, including but not limited to slips, falls, incidental contact, and any injuries, damage, and expenses resulting therefrom. By participating in a VAB program, I hereby assume said risk and release VAB and its officers, directors, employees, contractors, agents, students, host families, affiliates, and assigns from liability for injury, damage, medical expenses, other expenses, and costs, however arising. All students are responsible for ensuring that they have and maintain medical coverage either with British Columbia or their home province. *

Agree

Personal health care number*

Province health care card was issued:*

AGREEMENTS

I have read and understand the refund policy for my child's program (information available on the VAB website under "General Program"):*

Agree

I permit VAB to use images of my child on social media or in professional marketing materials. Student names will not be used/identified.*

Yes

No

How did you hear about VAB?:*

By agreeing to this Application, we hereby attest to the accuracy of the information provided herein, and agree to all terms and releases and give all authorizations contained herein.*

Agree

Date of Agreement:*

Word Verification: