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 *AddressApt, 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 boxes2020-2021 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 10-10:45amTap (ages 5 & up) Thursdays 4:15-5:15pmSong & Dance (ages 6 & Up) Saturday’s 2:15-3:15pmAcrobatics Level 1 (ages 5 & Up) Wednesdays 3:30-4:30pmAcrobatics Level 2 (ages 8+) Mondays 5:15-6:15pmPre-Ballet (ages - 5 & 6) Fridays 3:30-5:15pmPre-Primary Ballet (ages 6-8) Wednesdays 4:30-5:15pmBallet ( Age 9+) Mondays 6:15-7:15pmJazz 1 (ages 5-7) Mondays 3:30-4:15pmJazz 2 (ages 8+) Mondays 4:15-5:15pmHip Hop 1 (ages 5 -7) Saturdays 12:30-1:15pmHip Hop 2 (ages 8+) Saturdays 1:15-2:15pmAdult Jazz (ages 16+) Tuesdays 8:30-9:30pmFREE 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.Non-Season ClassesFall Silver Swans (Adult Ballet) Tuesdays 10-11am Session dates TBAConditioning Class with Renae Atchison ($16) July 7th at 7pmConditioning Class with Renae Atchison ($16) July 9th at 7pmAdditional 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 TERMS COVID LIABILITY RELEASE AGREEMENT Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), our business is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance. Symptoms of COVID-19 include: • Fever • Fatigue • Dry Cough • Difficulty Breathing I agree to the following: • I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. • I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days. • I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. • I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days. • I understand that the Dance Academy of Prince Rupert cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client. Our business will be following enhanced procedures to prevent the spread of COVID-19: • By signing below, I agree to each statement above and release The Dance Academy of Prince Rupert from any and all liability for unintentional exposure or harm due to COVID-19.SubmitCaptcha *reCAPTCHA is required.