Registration and Medical Release

Please be sure you have read our policies page before registering

Student Name *
Student Name
Birthdate *
Birthdate
Parent Name
Parent Name
(Not applicable to students 18+)
Address *
Address
Phone *
Phone
Secondary Phone
Secondary Phone
Please let us know if the student has any medical issues we should be aware of.
Name, phone number and relation to the student.
Membership Fee *
Payment Plan (for full year enrolment only) *
Waiver *
I understand that dance is a physically demanding activity that can occasionally result in an injury. I agree that Halifax Dance nor any of its officers, staff or instructors shall not be held responsible or liable for any accident or illness incurred by the student named above while attending any class, program or performance hosted by Halifax Dance and participating in related activities. I also understand that if the student has been prescribed remedial exercises by a medical practitioner or therapist and has not been doing those exercises as prescribed, and if the student must stop dancing as a result, no refund or credit will be issued. In the event that I (parent/guardian) cannot be reached in the case of an emergency or I (the student 18+) cannot give consent due to injury or illness, I hereby give permission to the physician selected by Halifax Dance to secure proper medical treatment for the student as is named on this form.
Photo Release *
I give permission for the student to be photographed and recorded in class while attending Halifax Dance. Halifax Dance may use these photographs and recordings in the future for archival and promotional purposes.

You will receive a phone call from our front desk staff to arrange payment for your registration. Your registration is not complete until  first payment is made.