Registration/Schedule

Parent/Guardian *

First

Last

Emergency Contact *

First

Last

Phone Number *

Email *

Emergency Phone Number *

Monday *

3:00-3:45 Ballet 5-6 yrs - Sara 1 SPOT LEFT! 3:45-4:30 Jazz 5-6 yrs - Sara 4:30-5:15 Jazz 7-9 yrs - Sara 6:00-6:45 Contemporary 7-9 yrs - Hannah 6:45-7:30 Contemporary 9-12 yrs - Hannah 2 SPOTS LEFT! 7:30-8:15 Contemporary 12 + yrs - Hannah

Tuesday *

9:30-10:00 Twinkle Toes 3-4 yrs - Sara SOLD OUT 10:15-10:45 Tots Hip Hop 3-4 yrs - Sara 3 SPOTS LEFT 3:30-4:00 Twinkle Toes 2.5-4 yrs - Sara 4:00-4:45 Ballet 5-6 yrs - Sara SOLD OUT 4:45-5:30 Hip Hop 9 + yrs - Sara 2 SPOTS LEFT 5:30-6:15 Hip Hop 5-6 yrs - Sara NEW 6:15-7:00 Tap 8 + yrs - Maddy 7:00-7:45 Dancer Conditioning 10 + yrs (This is not a performance class) - Alivia 7:45-8:45 Ballet Technique 10 + yrs (Must have a minimum of 2 yrs ballet experience. This is not a performance class) - Aliva

Wednesday *

2:55-3:25 Twinkle Toes 3-4 yrs - Sara 4 SPOTS LEFT 3:30-4:00 Tots Hip Hop 3-4 yrs - Sara SOLD OUT 4:00-4:30 Latin 3-5 yrs - Sara 2 SPOTS LEFT 4:30-5:15 Latin 6-9 yrs - Sara 2 SPOTS LEFT 5:15-6:00 Jazz 9-12 yrs - Hannah 4 SPOTS LEFT 6:00-6:45 Ballet 9-12 yrs - Hannah

Thursday *

3:00-3:45 Ballet 5-6 yrs - Sara 3:45-4:30 Hip Hop 5-6 yrs - Sara SOLD OUT 4:30-5:15 Hip Hop 7-9 yrs - Sara 5:15-6:00 Ballet 7-9 yrs - Hannah 2 SPOTS LEFT

Friday *

3:00-3:30 Hip Hop 5-7 yrs - Hailey 3 SPOTS LEFT 3:30-4:15 Breakdance 7-10 yrs - Spencer 1 SPOT LEFT 4:15-5:00 Tap 5-7 yrs - Demetria 1 SPOT LEFT

Payment Method *

Online (Credit Card) - Please go to the Online Payments page to set this up. Post-Dated Cheques (A $25 NSF fee will be applied to cheques that do not go through) We must receive your cheques for your spot to be reserved. Please e-mail us to arrange a drop-off time. Cash (Each Term must be paid in full. Please e-mail us to arrange a drop-off time). E-transfer (Each Term must be paid up front. Please send e-transfers to admin@srdanceacademy.ca with the password SRDA2018)

I understand that unless I notify SRDA before March 1, I am committed until the 2019 June Recital *

Yes

Attendance is mandatory. We are an affordable dance company but we

do our best to put on quality performances that the students are proud of

and this is not possible with poor attendance. If your child must miss a

class for any reason please inform your instructor as soon as possible.

BY SIGNING THIS DOCUMENT YOU AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

I hereby release and forever discharge Sara Raymond Dance Academy, its Directors, Employees, or Volunteers and its or their successors, of and from any claim, demand, damage, which may include a failure to properly safeguard against any dangers and hazards pertaining to the event, including, without limitation, the negligence of the agents, employees and instructors working with/for Sara Raymond Dance Academy. *

Yes

I hereby authorize the owner of Sara Raymond Dance Academy, the employees, volunteers, and subcontractors to medically assist your child. *

Yes

I give permission for photographs and videos to be taken of my child and used for the studio's promotion. This may include newspapers, websites, and social media. *

Yes

I certify that I am the legal guardian of the minor child that I have registered, or that I am the age of majority. I have read the terms and conditions and am bound to them. *

Yes

We the guarantor, if applicable, on behalf of ourselves, members of our family, hereby forever release, discharge and hold harmless members of Sara Raymond Dance for any injury arising out or in connection to taking dance class. *

Yes

February - June 2019 Season - Register Today!

204- 6750 N Island Hwy in North Nanaimo