Summer Dance Registration Form

Name:_____________________________________ Age:______
Address:______________________________________________
Phone:_______________________________________________
Email address:_________________________________________

Check program desired:
Program 1____
Program 2____


If not taking the full program please list the classes and times:
1.____________________
2.____________________
3.____________________


Total fee enclosed: $___________
Rates include GST

Cheques payable : Jennifer Stevenson

All fees must accompany registration form. Drop off or mail form to:
128 Dakota Ave
Penticton BC
V2A 8X1

WAIVER
The applicant, his/her parents and or guardian agrees Okanagan Dance Studios, it’s director, instructors and employees are not liable nor responsible for any accident or losses however caused, and agree to release same from all claims and or damages. I/We further agree that the applicant is in good physical health and has no medical conditions unless otherwise specified in writing.


 

Signature_________________________________________