Casey's Registration Form 2020-2021
*Please fill out one form per dancer.
Sign in to Google to save your progress. Learn more
Dancer's First Name *
Dancer's Last Name *
Birthdate *
MM
/
DD
/
YYYY
Medical Conditions/Allergies:
Parent/Guardian Name *
Street Address *
City *
Postal Code *
Phone Number 1 *
Phone Number 2
Email 1 *
Email 2
Class Registration (check all that apply).  Preschool class days/times can be selected here and will be filled on a first come first serve basis. *
Required
***PLEASE NOTE: THERE IS A NON-REFUNDABLE REGISTRATION FEE OF $30.00 that will be due September 1st, 2020 with the first lesson payment. *
Required
I AUTHORIZE CASEY'S DANCE CENTRE LTD. TO PUT THROUGH ALL LESSON FEE PAYMENTS ON MY CREDIT CARD. (Please check if you agree) A signature will be required at the beginning of your dance session and you will receive a phone call to set up your credit card information on file. *
Required
COVID-19: I understand and agree that even with social distancing and sanitization protocols, there is a possibility of contracting the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus which can lead to the COVID-19 (coronavirus disease) while attending Casey’s Dance Centre Ltd.  I voluntarily agree, therefore, to assume all risks and responsibility of contracting the SARS-CoV-2 virus, which me or my child may contract during any of Casey's Dance Centre Ltd. classes, rehearsals, performances, or activities.  I also exempt and release, Casey's Dance Centre Ltd. and its owners, employees, assistants, volunteers, guest artists, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with SARS-CoV-2 and COVID-19. I agree and give full consent to active symptom screenings for my child which may include a temperature check.  I understand and agree that I will not send my child to Casey's Dance Centre if they are sick even if symptoms resemble a mild cold.  Symptoms to look for include fever, cough, shortness of breath, sore throat, runny nose, nasal congestion, headache, and a general feeling of being unwell. I understand and have made my child aware that they are to inform a Casey's Dance Centre Ltd. staff member immediately should any of the above-mentioned symptoms develop while at Casey's Dance Centre Ltd.  Should this occur, I understand my child will be isolated until they are picked up by a parent or guardian.  I understand it is my responsibility to ensure my child is picked up immediately when notified. I understand and agree that CMOH Order 05-2020 legally obligates individuals who have a fever, cough, shortness of breath, sore throat, runny nose (that is not related to a pre-existing illness or health condition) to be in isolation for 10 days from the start of symptoms or until symptoms resolve, whichever takes longer. I have alerted Casey's Dance Centre Ltd. of any and all medical conditions and allergies of my child.  I understand it is especially important to alert Casey's Dance Centre of any health conditions my child has which may causes similar symptoms of SARS-CoV-2 and/or COVID-19.  These health conditions and symptoms include but are not limited to a cough and/or shortness of breath due to asthma or exercise induced asthma, and/or a sore throat, runny nose and/or nasal congestion due to severe seasonal allergies. If I am signing this waiver for my child or children, I certify that I am the parent or legal guardian and have the right to waive these rights. *
General: I understand and agree that in participating in any dance class, rehearsal, audition or performance, there is a possibility of physical injury or death.  I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Casey's Dance Centre Ltd. classes, rehearsals, performances, or activities.  I also exempt and release, Casey's Dance Company Inc and its owners, employees, assistants, volunteers, guest artists, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Casey's Dance Centre Ltd.  I have alerted Casey's Dance Centre Ltd. of any and all medical conditions and allergies on my registration form.  If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. *
Privacy: Permission is granted to Casey's Dance Centre Ltd. to use photographs and video of students for promotional and publicity purposes. *
Payments & Cancellations: We/I am aware of the following: a. An interest charge of 5% per month will be applied to all amounts 60 days past due and acknowledge that we/I will be responsible for paying all amounts and associated interest charge(s) in full by the end of the dance season; b. There is a $25.00 service charge on any NSF cheques; c. We/I understand the withdrawal policy and will provide one month written notice in the event my child(ren) withdraw prior to March 1, 2021. We/I acknowledge that we/I are responsible for paying all fees to the end of the notice period. We/I acknowledge there is no withdrawal and no refund of fees after March 1, 2021.  *Please note that classes may switch from in-studio to an online format at any point as mandated by Alberta Health Services. By registering at Casey's Dance Centre Ltd., you are agreeing to participating in both in-studio and online class delivery.  Refunds/ Credit will not be given for changes to programming delivery. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms