Registration Form

Registration 2021-2022

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
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GENDER:
DATE OF BIRTH*

DD slash MM slash YYYY
NAME OF STUDENT 2

First

Last
Hidden

GENDER:
DATE OF BIRTH

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*

This number may be used to contact parents/caregivers in case of an emergency with your child.
DOES YOUR CHILD HAVE ANY HEALTH CONDITIONS THAT THE SCHOOL SHOULD BE AWARE OF?

e.g. please let us know of any food allergies, dietary restrictions, etc.
HOW DID YOU HEAR ABOUT US?
IS THERE ANY OTHER INFORMATION YOU WOULD LIKE US TO KNOW?
DANCE & ART SUMMER CAMP (9am -12pm)*
- Week 1 (July 18 – 22)
- Week 2 (July 25 – 29)
Summer Camp for ages 4 to 7. Campers must be 4 years old by the start date.
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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 and/or chills ● Cough or barking cough ● Shortness of breath ● Decrease or loss of sense of taste or smell ● Nausea/vomiting, diarrhea
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 symptoms associated with COVID-19, or tested positive for COVID-19 in the last 14 days and will remain at 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*

MM slash DD slash YYYY
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Get in touch

416-519-3979

Registration 2021-2022

Student Name	Class Name	Day	Class Time