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Student Name *

First Name

Last Name

Birthday

MM

DD

YYYY

Student Preferred Pronouns *

She/Her

He/Him

They/Them

Other

Guardian Name

(Not applicable to students 18+)

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Secondary Phone

(###)

###

####

Terms *

Full Year

Term 2 (January-June)

Baby & Me

Adult Winter

Summer Camp

Costume Fee $25 *

Halifax Dance is lucky to have a large wardrobe that is used each year for the annual June Showcase. A $25 fee is charged to each student as a maintenance and costume construction fee.

I agree

Adult Student or Camp Registration (not applicable)

Membership Fees *

Membership Fee is non-refundable. Halifax Dance is a not for profit, membership-based organization. As such, all students pay an annual $30 membership fee that entitles you to a vote at the Annual General Meeting.

Already a member

Single Membership ($30)

Family membership ($65)

Not Applicable (Baby & Me or Camps)

Payment Plan (For Full Year Enrolment Only) *

Pay in Full

2 Payments ($30)

4 Payments ($55)

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.

I agree

I do not agree

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.

Yes

No

Specific consent for photos used in formal advertising campaigns, including materials like brochures and billboards.

Yes

No

Covid Waiver *

I agree that I have read the document “Halifax Dance COVID-19 Health & Safety Protocols” I agree that I will stay home, or keep my dependent home from all Halifax Dance events and commitments if showing any symptoms of COVID-19. Symptoms include: fever or chills a new or changed chronic cough a sore throat or difficulty swallowing a runny or stuffy nose shortness of breath or difficulty breathing I agree that Halifax Dance will not be held liable for exposure to COVID-19. I understand that a refund will be unavailable if policies are not adhered to. I have read and agree to the above terms.

Yes

No