Jasper Dance ProgramWinterSession 2018 Registration Form

Name______New Student: Y/N

Parent’s/Guardian’s name______Date of Birth______Age______Grade______

Phone Numbers: home______work______cell______

Email______Postal Box No.______

Allergies or medical conditions: ______

Class(es) taking:______

Liability Waiver: I, the undersigned, being 18 years of age or older, on behalf of the student named above, understand that Jasper Dance Program and the instructors thereof are not liable for personal injuries or loss of, or damage to, personal property. I understand that participating in dance classes involves the possibility of physical injury. I therefore assume all risks involved in the participation of Jasper Dance Program classes, whether it may be I, or my participating minor child. I exempt, release and indemnify Jasper Dance Program from any and all liability claims, demands or causes of action whatsoever from any damage, loss or physical injury to myself or my participating minor child. I understand that each student may decline to participate in any activity.

I further acknowledge that photos and videos taken during the season may be used for promotional purposes or posted on our website Facebook or Instagram.

By signing below, I am acknowledging that I have read and agree to be bound by all the rules and regulations as stated on this form.

Signed______Print name______Date______

(Signature of participant or Guardian if under 18)

CLASSES start week of January 8 (unless otherwise noted). Final Concert is on April 29, International Dance Day!

REGISTER on Thursday January 4, 3:00-700pm in the lobby of the Jasper Activity Centre or online. Classes will be held in the Jasper Dance Program Studio, downstairs at the Activity Centre.

*Full Sessions starting January 8, ages 3.5–18(includes costume fee): $220.00 * 8 week sessions: $120.00

*4 week sessions: $60.00 * Zumba 4 week session: $48.00, drop in $14.00

Payment is accepted by cheque, etransferscredit card (via Paypal) or cash. Please make chequespayableto Nicole Koebel, postdated cheque(s) are accepted. After February 27 there will be a $25.00 late charge applied to any outstanding balances. (Any returned cheques $25.00 fee.) Students with outstanding dues will not be allowed to register in next session until fees are paid in full. Refunds ($25.00 charge) will be dealt with on an individual basis (see refund policy for details).

The correct footwear is required for all classes: indoor runners for hiphop (no black soles) and jazz shoes for Jazz class, ballet slippers or foot undeez for Ballet/Modern/Lyrical. (Shoes are available from Nicole, both new and used). Students are required to have proper dance attire and hair tied back for class. See for shoe order forms and dress code policies. Minimum 5 students per class, maximum 8-14 students depending on age group. Class times are subject to change.

I'm looking forward to seeing everyone this new year!!! Please call me at 852-1927, text 852-8413 or email if you have any further questions or concerns, thank you! Nicole Koebel

Website: Facebook: Jasper Dance Page Instagram: Jasper_Dance_