CALGARY STUDIOS OPEN DIVISION 2014–2015 Master Class Series Registration “Dance with a Sugar Plum Fairy”

STUDENT INFORMATION

Student Name: _____________________________________________________________________________

Birthdate: _________________________________________________________Gender: M / F

Address: _____________________________________________________________________________

City: _________________________________ Postal Code: ________________________

PRIMARY PARENT/GUARDIAN INFORMATION (first contact for child) Parent Name: ____________________________________________________________________________

Mailing Address (if different from student):_______________________________________________________

City: _________________________________ Postal Code: ________________________

Phone Number - Home/Cell :_______________________ Work: ________________________

Email: _____________________________________________________________________________

REGISTRATION

Where: School of Alberta Ballet

2nd floor, West Annex

906 12 Ave SW, Calgary AB T2R 1K7

When: Sunday, Nov 30, 2014

Please select your class.

□

Age 6-8 11:00 to 12:00

Max capacity - 20 $25

□ Age 9-12

12:30 to 2:00

Max capacity - 25 $30

□ Age 13 and up

2:00 to 3:30: Ballet

3:45 to 4:45: Sugar Plum Fairy

Variation Class (flat shoes only)

Max capacity - 25

$45

METHOD OF PAYMENT

□Cheque □Cash □Debit □Visa □Mastercard

Please make all cheques payable to School of Alberta Ballet

Name on Card: ____________________________________________________________________________________

Card Number: _________________________________________Expiry Date:______________Security Code: _______

Signature: ____________________________________________________________________________________ HEALTH AND EMERGENCY INFORMATION EMERGENCY CONTACT If a Parent or Guardian is not available in case of emergency, please contact (must reside in Calgary): Name: _______________________________________________ Phone Numbers:_______________________________ Nut Allergies: Given the nutritional training needs of our students, the School of Alberta Ballet sells nut-based products. When possible, the School makes all attempts to reduce the amount of peanut-based products, but almonds and other nuts are regularly found in our nutritional or protein bars. Traces of peanuts may also be found in many of these products. Further, we reserve the right to offer peanut-based products at our sole discretion. Students and families must be keenly aware of this prior to registering at the School of Alberta Ballet. All students attending the School of Alberta Ballet are expected to carry some form of Health Insurance, whether provincially issued or purchased separately. Please list any previous health or injury concerns of your child that you feel the School of Alberta Ballet should be aware:

___________________________________________________________________________________________________ PARENT/GUARDIAN EMERGENCY MEDICAL TREATMENT WAIVER If the student should require medical attention of any sort while in attendance at or during travel to, from, or in connection with the School of Alberta Ballet or a School of Alberta Ballet event or performance, the School’s staff is hereby empowered to administer first aid, have the student transported to a doctor or hospital, have the student examined and treated by a doctor, and take whatever action the School of Alberta Ballet may deem necessary to protect the student’s health and welfare. I/We agree to pay for any such medical procedures or treatment, and agree to release, hold harmless, and indemnify the School of Alberta Ballet as outlined in this agreement. In the case of an emergency, during which we or the emergency contact designate are unable to be reached, we hereby give our permission to the teacher accompanying our son/daughter to sign a consent for medical treatment in our absence. Primary Parent/Guardian Signature: ________________ __________________ Date: _______________________ Secondary Parent/Guardian Signature: ___________________________________Date:_______________________ POLICY AGREEMENT I ______________________________________(student) and _______________________________(parent) agree to abide by all policies as laid out in The School of Alberta Ballet Open Division Student Handbook, which can be found at:www.schoolofalbertaballet.com/about-us/documents CONFIRMATION OF ENROLMENT ________________ _________________________________ ___ __________________________________ Date Student Name Parent Signature

Please fax (403-245-2293) or email (calgarystudios@albertaballet.com) your completed registration Thank you for choosing the School of Alberta Ballet