Registration for fall classes and Summer Programs are now being accepted!! Register online to reserve placement. Please do not delay as classes are filling up quickly! If you are human, leave this field blank.Online Registration Form: Please register online to reserve placement for any of our programsInstructionsPlease complete the following form. You can select one or more classes. This will reserve your spot in our class(es). Someone from our office will then contact you regarding payment. Thank you for registering and welcome to the Dance Academy of Prince Rupert! Complete Your Information:Please complete all required information DateEmail *Secondary or Student EmailAddressApt, suite, etc.CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codePhoneCell PhoneFirst and Last Name of Dancer *Date of Birth (Month/Day/Year)GenderFemaleMaleGuardian (1) First and Last Name *Guardian (2) First and Last NameMedical Conditions or Special NeedsPlease list any allergies, medical conditions or special needs the Studio should be aware of.New to Dance Academy? How did you hear about us?Word of Mouth ( friends/family)NewspaperLocation/ SignageSocial Media (ie Facebook, Instagram)Online (Web Page)PosterRecital or other community performancesPlease check one or more boxesReferralIf you were referred by a current Dance Academy Client please state their name HEREProgram ChoiceRecreational ProgramCompetitive Program ( DAPR Team)Please Check One2019-20 Regular Season ClassesRhythm & Dance (pre-school dance ages 3-4) Tuesdays 1:15-2pmRhythm & Dance (pre-school dance ages 3-4)Wednesdays 10-10:45amRhythm & Dance (pre-school dance ages 3-4) Saturdays 9:30-10:15amBoys Only Tumbling ( ages 4-7) Mondays 5:15-6pmTap (ages 5 & up) Mondays 4:15-5pmSong & Dance (ages 6 & Up) Tuesdays 3:30-4:30Acrobatics (ages 6 & up) Thursdays 4:30-5:15pmPre-Ballet (ages - 5 & 6) Tuesdays 4:30-5:15pmPre-Primary Ballet (ages 7) Tuesdays 5:15-6pmBallet ( Age 8+) Thursdays 5:30-6:30pmJazz 1 (ages 5-8) 3:15-4:30pmJazz 2 (ages 9+) Tuesdays 6-7pmHip Hop 1 (ages 5 -7) Saturdays 10:15-11amHip Hop 2 (ages 9+) Saturdays 11-12pmFREE TRIAL CLASS! Please check the above class your child would like to tryI am unsure about class selection. Please contact me by telephone so that all options can be explained to me in personCompetitive Level Classes (please contact the studio directly)Please check one or more classes.DAPR 8 Week ClassesFall Silver SwansToddler & U (Ages 1.5-3) Session One: Sept 4- October 23rd 2019ADULT JAZZ Ages 16+ ($126) Wed 8-9pm Sept 4- October 23rd 2019Additional InformationPlease use this space to inform us of any additional information regarding your dancer or to address any questions or concerns regarding registration or classes. We will contact you with a response as soon as possible:)Liability and ReleaseAgreeLiability: The Dance Academy of Prince Rupert, its’ proprietor, or those in its’ employ are not liable for any injury, sickness or disability which occurs due to the physical activity of dance; any loss of or damage to personal property, whether it be at the studio, competition, event or travel. I exempt, release and indemnify the Dance Academy of Prince Rupert and any and all persons related to the Dance Academy of Prince Rupert 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. Release of Information: I hereby give the Dance Academy of Prince Rupert permission to release my personal contact details to staff and parent volunteers for the purpose of contacting me regarding my participation in the Dance Academy of Prince Rupert. Voluntary termination: One month’s written notice is required. One month from the receipt of the letter will be charged as an administration fee, the remaining tuition will be returned to you. It is the students choice if they wish to finish out the month after their notification. If a class is cancelled by the Academy a full refund of the remaining tuition, will be issued. Costume deposits will not be refunded after October 31st Tuition: Tuition fees can be paid in 1, 3 or 10 payments by cheque, Visa, and/or Mastercard. Please note – Cash or debit must be paid in 3 term payments. The 10 payment option is an equal divide of fees, not a monthly fee, and does not correspond to how many classes are in a month. If tuition fees are not paid when due the student will be removed from classes until the account is settled. For emergencies, please contact the bookkeeper so arrangements can be made. All costume deposits are due at registration. There is a $25 charge for returned cheques. Interest will be charged on overdue accounts. If the student’s surname is different from the surname on the cheque please write the student’s name in the memo section on the cheque. I AGREE AND ACCEPT THESE TERMSSubmitCaptcha *reCAPTCHA is required.