Student Name
*
First Name
Last Name
Birthday
MM
DD
YYYY
Student Preferred Pronouns
*
If other, please specify
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
(###)
###
####
Email
*
Medical Alert
Please let us know if the student has any medical issues we should be aware of.
Contact person in case of emergency (other than parent if under 18) *
*
Name, phone number and relation to the student.
MSI Number
Class
*
Please Select
March Break Camp (Members)
March Break Camp (Non-Members)
Camp Relevé
Acro 1
Acro 2
Pre-Ballet B
Ballet 1A
Ballet 2A
Ballet 2B
Ballet 3A
Ballet 3B
Ballet 4/5
Breakdance A
Breakdance B
Breakdance C
Creative 1
Creative 1/2 A
Hip Hop A
Hip Hop B
Hip Hop C
Mini Hip Hop A
Jazz 1
Jazz 2
Pre-Teen Ballet
Pre-Teen Jazz
Tap 1/2
Tap 3/4
Tap Foundations
Teen Jazz
Teen Ballet
Inclusive Movement Youth A
Inclusive Movement Youth B
Inclusive Movement Teen
Inclusive Movement Adult
Monday Adult Open Barre
Monday Adult Beginner Pointe
Tuesday Adult Contemporary
Wednesday Adult Jazz
Wednesday Adult Ballet Beginner+
Wednesday Adult Beginner Tap
Wednesday Adult Open Tap
Wednesday Adult Ballet Basic
Wednesday Adult Performance Class
Wednesday Adult Intermediate Pointe
Thursday Adult Open Ballet
Thursday Adult Combo's & Choreo
Thursday Adult Ballet Beginner
Summer Camp Jul 7 - 11 FULL-DAY
Summer Camp Jul 14 - 18 FULL-DAY
Summer Camp Jul 21 - 25 FULL-DAY
Summer Camp Aug 11 - 15 FULL-DAY
Summer Camp Aug 18 - 22 FULL-DAY
Summer Camp Jul 7 - 11 HALF-DAY
Summer Camp Jul 21 - 25 HALF-DAY
Summer Camp Aug 11 - 15 HALF-DAY
Terms
*
2nd Class (If applicable)
How did you hear about Halifax Dance
Returning Student
Referral from a current member
Community Event
Online Search
Social Media
Print Advertisement or Billboard
Facebook Ads
Other
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.
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.
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.
