Registration Form

Registration 2020-2021

Please fill out this form and proceed to the store to complete your registration. In order for your registration to be accepted, the completed form must be submitted along with the store purchase.

NAME OF STUDENT*

First

Last
GENDER:
DATE OF BIRTH*

Date Format: DD slash MM slash YYYY
NAME OF STUDENT 2

First

Last
GENDER:
DATE OF BIRTH

Date Format: DD slash MM slash YYYY
PARENT 1:*

First

Last
PARENT 2:

First

Last
ADDRESS*

Street Address

City

Province

Postal Code
EMAIL*

All school information will be sent by email to Parent 1. Please ensure you have provided your primary email address.
PREFERRED PHONE NUMBER*
DOES YOUR CHILD HAVE ANY HEALTH CONDITIONS THAT THE SCHOOL SHOULD BE AWARE OF?
HOW DID YOU HEAR ABOUT US?
IS THERE ANY OTHER INFORMATION YOU WOULD LIKE US TO KNOW?
SESSIONS*
- Spring Session (Apr – June)
CLASS REGISTRATION:*

Student Name Class Name Day Class Time
CONFIRMATION:*
- Yes, I understand and agree with Leaside Dance School’s fees and policies and to the terms and conditions as stated on this form and as they appear on the school’s website (www.leasidedance.com).
CONFIRMATION:*
- I agree that Leaside Dance School and its associates and employees are not responsible for injury, loss, illness, etc by students, parents or guardians arising out of connection with activities of the school. Parents are responsible for the safe transport of their child to and from classes. I allow Leaside Dance School to use pictures and/or video of the registered student for school purposes.
SCREENING CONFIRMATION:*
- I agree that before my child attends class each time, I will complete a self assessment check for the following symptoms, including a temperature check, and will not attend class if any of the following are present:
● Fever ● New onset of cough ● Worsening chronic cough ● Shortness of breath ● Difficulty breathing ● Sore throat ● Difficulty swallowing ● Decrease or loss of sense of taste or smell ● Chills ● Headaches ● Unexplained fatigue/malaise/muscle aches ● Nausea/vomiting, diarrhea, abdominal pain ● Pink eye (conjunctivitis) ● Runny nose/nasal congestion without other known cause.
SCREENING CONFIRMATION*
- I agree that my child will not attend class if any anyone in my family had close contact with someone with acute respiratory illness or travelled outside of Ontario in the past 14 days. I agree that my child will not attend class if they, or a member of their household, have tested positive for COVID-19 in the last 14 days and to remain home until a negative test or confirmation from their doctor that it is safe to return to class. I agree to report all absences to the school by email, especially if a member of my household is experiencing COVID symptoms or has tested positive for COVID-19 for contact tracing purposes.
DIGITAL SIGNATURE:*

First

Last
DATE*

Date Format: MM slash DD slash YYYY
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Get in touch

416-519-3979

Registration 2020-2021

Student Name	Class Name	Day	Class Time