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Registration date: _________________________

2019/20 Registration

Full Year Classes *Early Bird Registration Student’s Last Name: _______________________________________________

Student’s First Name: ___________________________________________________

Medical Concerns (and allergies): ___________________________________________________________________________ ________________________________________________________________________________________________________ ______________________________________________ Date of birth: ___________________________________

*Note: please consult the appropriate medical advisor to determine if this activity is suitable for the student registering *Note: if the student requires an epipen, please indicate – can they administer it themselves? Do they have it with them at all times?

( m m / d d / y y ) Contact Information: Address: _______________________________________________________ Home phone #: _________________________ City: ______________________________ Postal code: _________________________ Family Email: ____________________________________________________________________________________ *Important: we use email for much of our communication with our students’ families Student’s Email: __________________________________________________________________________________ (for students in Vocational levels) Parents or Guardians (or Emergency Contact):

1. Name: _______________________________________ Relationship to student: _______________________________

Phone #: _____________________________________ Alternate Phone #: ___________________________________

2. Name: _______________________________________ Relationship to student: _______________________________

Phone #: _____________________________________ Alternate Phone #: ___________________________________ How did you hear about Crossings?

! Returning customer ! From a Crossings family: ___________________________________ ! Crossings website or Facebook

! Other: __________________________________________________

What school does the student attend?

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Student’s Name: ____________________________________ Early Bird (before May 11, 2019) Regular Registration CLASS SELECTIONS or PROGRAM LEVEL Style Level Day Time Length (hrs)

___________________________ ________________________ __________ ___________________ __________

___________________________ ________________________ __________ ___________________ __________

___________________________ ________________________ __________ ___________________ __________

___________________________ ________________________ __________ ___________________ __________

___________________________ ________________________ __________ ___________________ __________

___________________________ ________________________ __________ ___________________ __________

___________________________ ________________________ __________ ___________________ __________

FEE SUMMARY (for office staff to complete): *Early Bird Rates Length Rate Quantity Fees 0.5 hrs 0.75 hrs 1 hr

$512 $682 $762

________

________

________

$ ____________________ $ ____________________ $ ____________________

1.25 hrs $830 ________ $ ____________________

1.5 hrs $910 ________ $ ____________________ Total after Multi-Class Discount $ ____________________ Add-Ons: Conditioning &Stretch $650 ________ $ ____________________

Paid In Full Discount (5%) – $ __________________ *On/before August 1st, 2019

Total after Paid In Full Discount $ ____________________ Deposit:

Costume fee(s) $ ____________________

Recital video link ($10) $ ____________________

Registration fee $ ____________________

Total before tax $ ____________________

GST $ ____________________

Total after tax $ ____________________

Credit card administration fee** $ ____________________

Total fees

$ ____________________

( 2.0%) **We recommend that payment be made with cheques when possible. If you choose to pay with Visa or Mastercard, the credit card administration fee will be calculated after tax to account for the cost of processing these transactions.

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PAYMENT SCHEDULE (for office staff to complete): " Pay in Full

(On/before August 1st, 2019 by eTransfer, post-dated cheque or credit card payment)

Date: _______________________________ Amount: $ _______________ CHQ#/Auth#/eTransfer pw: ______________

OR " Payment Schedule

(Deposit (costume fee(s) + registration fee + gst) AND five post-dated cheque or pre-authorized credit card payments spanning September through January due on either the 1st or the 15th of each month. ***Accounts are to be paid in full on/by January 15th, 2020.)

! If applying for Jumpstart or KidSport funding, these payments will be applied to your client account and fees will be adjusted

to reflect these payments. A non-refundable deposit and AND five post-dated cheque or pre-authorized credit card payments are still required upon date of registration.

Deposit: (date) ______________________ Amount: $ _______________ CHQ#/Auth#: _______________

September ______, 2019 Amount: $ _______________ CHQ#/Auth#: _______________

October ______, 2019 Amount: $ _______________ CHQ#/Auth#: _______________

November ______, 2019 Amount: $ _______________ CHQ#/Auth#: _______________

December ______, 2019 Amount: $ _______________ CHQ#/Auth#: _______________

January ______, 2020 Amount: $ _______________ CHQ#/Auth#: _______________

Total: $ _________________ CHEQUE PAYMENTS

1. Cheques should be made payable to “Crossings Dance”. 2. Post-dated cheques are to be submitted at the time of registration. 3. Returned cheques will be assessed a service charge of $25.00.

My initials here indicate that the cheque policies have been read, understood and accepted: ___________ OR CREDIT CARD PAYMENTS

1. The above detailed fees will be processed to my credit card by Crossings Dance Ministries Inc. 2. Declined credit cards will be assessed a service charge of $25.00. 3. I agree to notify Crossings of any changes to my credit card information including a new credit card number or expiry

date by emailing info@crossingsdance.com. If new information is not provided to Crossings, and my credit card is declined as such, the above policy regarding a $25.00 service charge will be applied.

Name on card: ___________________________________________

Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiry date: __ __ / __ __

I have read and understood, and I accept the above polices. I authorize Crossings Dance Ministries Inc. to charge my credit card as detailed above: Signature: __________________________________ Date: ______________________

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Policies

Full Year Classes Withdrawal Policies:

1. The initial deposit (costume fee(s) + registration fee + gst) is non-refundable. 2. The first month’s tuition is also non-refundable. 3. Withdrawals require one calendar month's written notice and must be received prior to the first day of the

month. Your final balance will be calculated by pro-rating classes (based on full, non-discounted rates) to the end of the one-month notice period. Any fees submitted to cover classes after the one-month notice period will be returned.

4. There are no refunds after January 31st, 2020. General Policies

1. Crossings Dance reserves the right to reschedule, cancel, or combine classes should registration be insufficient.

2. To register for any Ballet class above and including Pre-Junior 2, students will automatically be enrolled in both Ballet classes for their allotted level (twice per week).

3. To register for any Vocational 1/2 Ballet classes, students will automatically be enrolled in both Ballet classes and Pointe.

4. To register for any Modern or Jazz class above and including Junior 2, students will automatically be enrolled in both Modern and/or Jazz classes for their allotted level (twice per week).

5. Classes at a Junior 1 level or above, require students to enroll in at least 2 dance classes per week (Does not apply for Teen, Tap, or Musical Theatre classes)

6. Mature students (graduates) may design their own program apart from these requirements in discussion with the Director.

7. Classes at the Vocational level that receive less than eight registrants are subject to rate reassessment. Privacy Policy

1. Your personally identifiable information is kept secure. Only authorized employees have access to this information. Crossings will never share your personal information with any other person, company or organization.

Release and Waiver:

1. For purposes such as education and promotion of Crossings Dance Ministries Inc. and its programs, photographs and video may be taken of students and used in school publications, on our website, on our blog, on Facebook, in occasional news releases, and in other promotional mediums. Crossings Dance Ministries Inc., as applicable, is not required to notify students or their parents/guardians, solicit their approval, or compensate them in any way prior to using such photographs or video.

2. In order to teach and correct dance movement and technique, physical contact between the student and teacher is necessary. Crossings Dance Ministries Inc. undertakes to ensure that such contact is applied in a professional manner and is required for dance instruction. This contact, as deemed necessary by the teacher, is consented to by the student and/or parent/guardian.

3. Crossings Dance Ministries Inc. and its Directors and Employees will not assume liability for any lost or stolen property, for any bodily or personal injury consisting of or arising out of a student participating in any physical training (dance or fitness), athletic activity or contest. Crossings Dance Ministries Inc. is not responsible for loss, damage or injury to any person or property while on the site of Crossings Dance Ministries Inc., traveling to or from the site of Crossings Dance Ministries Inc., or while participating in an off-site affiliated performance, activity, or contest.

I have read and understood, and I accept the above polices:

Printed Name: ___________________________________________ Signature: _______________________________________________