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Registration and Medical Release

Please be sure you have read our policies page before registering

Student Name *
Student Name
Student's Preferred Pronoun *
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.
Costume Fee $20 *
Halifax Dance is lucky to have a large wardrobe that is used each year for the annual June Showcase. A $20 fee is charged to each student as a maintenance and costume construction fee.
Membership Fee *
Membership Fee is non-refundable. Halifax Dance is a not for profit, membership-based organization. As such, all students pay an annual $25 membership fee that entitles you to a vote at the Annual General Meeting.
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 *
Performance videos: all Halifax Dance performances are professionally recorded for archival and DVD sale purposes. In order to perform in Halifax Dance shows, we require that you consent to be in these videos. Consent to performance videos applies to all performances going forward. If you do not wish to participate in Halifax Dance shows please speak with Program Director Kate Houston about options. General consent to video and photographs taken at Halifax Dance or other performance and rehearsal locations for use in social media, company reports, show programs, etc.
*
Specific consent for photos used in formal advertising campaigns, including materials like brochures and billboards.
By registering for classes at Halifax Dance you are deemed to consent to receive both essential and non-essential communications. Essential communications include all communications required for full participation in classes and are essential to receive services. Non-essential communications include information about events, fundraisers, and general updates about the Halifax Dance. Please click here if you would like to opt-out of non-essential communications.

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.