Dance Registration Form - Term 2, 2013

AIR & PAASA

DANCE THEATRE Term 2 - 2013

Firm Fitness Gym

Suite 69, Winchester Business Centre

15 Hope Road, Kingston 10

Tel: 942-9693 Mob: 405-2800 Digicel 

Email: airpaasa@yahoo.com    

• Download registration form in word doc.
• Download registration form in pdf 

Complete and return this form with payment to AIR & PAASA Foundation Limited

Child's Full Name

Address:

Post Code

Home Phone:

Mobile:

&

Date of birth

D

D

M

M

Y

Y

Y

Y

Age as of January 1st, 2013

Gender

M

F

ENROLEMENT – ONE FORM PER STUDENT

Please select the program/s you wish to participate in:

Tick	Time From - To	AGE	Tuesday	Thursday	Saturday	Monthly	Term
	9:30 – 11:00	5 – 12 yrs	-	-	Intro to dance	$2,500.00	$6,500.00
	12:00 – 13:30	13+ yrs	-	-	Contemporary	$2,500.00	$6,500.00
	3:00 – 4:00	5 – 8 yrs	Folk	Ballet	-	$3,500.00	$10,000.00
	4:00 – 5:00	9 – 12 yrs	Folk	Ballet	-	$3,500.00	$10,000.00
	Full Program	5 – 12 yrs	X	X	X	$5,000.00	$12,000.00
	6:00 – 7:00	Adults	Reggae	Soca	Dancercise	$3,500.00	$9,500.00
	Calculate your total here:					$	$

• Please add $500.00 registration fee to the total.
• Please make cheques payable to AIR & PAASA FOUNDATION LIMITED. 

EMERGENCY & MEDICAL INFORMATION

Do you suffer from any serious ailment or injury?	YES		NO
Have you recently been hospitalized?	YES		NO
Do you suffer from any allergies?	YES		NO
Are you taking any form of prescribed medication?	YES		NO
Are there any other reasons why you may not participate fully in the program?	YES		NO
DO YOU HAVE AMBULANCE COVER & MEDICAL INSURANCE?	YES		NO

If you answered yes to any of the above, please provide us with more details:

Please provide details of parents and Guardians here:

Parents' Guardians' Name:
Address:
Phone:
Mobile:
Emergency Contact Name:
Phone:	Work:	Mobile:

REFUND POLICY

A) Where an Enrolment is subsequently Withdrawn, Refunds may be applied subject to the following

circumstances & conditions:

1. Where written notice of withdrawal is received prior to & up to 30 January 2013 a Refund will be awarded subject to a 30% cancellation fee.

2. Where written notice of withdrawal is received after 30 January 2013 a Refund will not be awarded and a

cancellation fee of 100% will be applied.

3. Where a student suffers from Total incapacitation due to medical reasons a full refund (less $500 Cancellation

Fee) will be award only where a detailed medical certificate is provided. The medical certificate must state that

the student is suffering from Total Incapacitation at the time of the program.

4. Should any of the programs be cancelled due to insufficient numbers, students will be entitled to a full refund.

5. Advanced notice in writing is required for any applications for refunds (except item A3). No refunds will be

considered after the completion date of each program.

B) Fees are non-transferable to another person or deferral to another date.

C) Partial refunds will not be issued for non-attendance.

DECLARATION

I/WE, the undersigned person/s, understand and accept the terms and conditions of enrollment.

I/We warrant that the student is physically fit and able to participate in the dance program.

I/We acknowledge that at all times while the student is at AIR & PAASA DANCE THEATRE program at the Firm Fitness Gym premises, the student is responsible for his/her property and in attending classes is participating at his/her own risk.

I/We agree and acknowledge that AIR & PAASA reserves the right to solely determine the appropriate class / group appointment for each student.

In consideration of AIR & PAASA FOUNDATION LIMITED accepting this application and providing the services to the student, I/we agree to release and indemnify AIR & PAASA FOUNDATION, the Firm Fitness Gym, our officers, employees and contractors from and against any claim, demand or liability for any injury, loss or damage whatsoever and howsoever caused. In the case of an emergency, I (student over 18 or parent legal guardian) authorize AIR & PAASA to seek medical assistance, including ambulance costs, if necessary and I agree to cover any costs incurred.

_________________________________________________________ ___________________________________

Parent or legal guardian’s signature (18 years old & over)

Name: ________________________________ Signature:____________________________ Date: ___ / ___ / ___

IMPORTANT:

 Parents: please collect students immediately after their last class. Late pick up will incur a fee $200.00

 Scholarship winners are awarded a scholarship prize subject to the terms & conditions of

the Scholarship Award. Please ask for further information

 RETURN THIS FORM BY January 30 , 2013. Numbers are limited so please remit completed forms ASAP. 

If you wish to order a T-shirt for the end of term performance... Please indicate your t-shirt size here: ____________ ($1000.00 each)