Student Registration Form

Student First Name*

Student Last Name*

Student Age*

Date of Birth*

Sex* FemaleMale

Street Address*

City*

Postal Code*

Student's Phone #*

Student Phone Type* HomeCellWork

Student's Email Address*

Children/Teens:

Parent(s) or Guardian name

Parent's Home Phone

Parent's Cell Phone

Parent's Work Phone

Parent's Email

Academic School

Grade

All Students:

Other family members in this academy

Number of years in dance*

Please list any medical conditions, allergies, physical limitations we should be aware of:

Desired classes:

GENERAL PROGRAM: check all that apply
Advanced 1 BalletIntermediate BalletGrade 4/5 BalletGrade 3 BalletPrimary/Grade 1 BalletPre-School Ballet/Creative DanceSenior Ballet TechniqueIntermediate Ballet TechniqueJunior Ballet TechniqueInter/Senior PointeAdvanced 2 ModernAdvanced 1 ModernIntermediate ModernGrade 6/Intermediate Foundation ModernGrade 5 ModernGrade 4 ModernGrade 2 ModernGrade 1 ModernAdvanced 1/2 TapIntermediate TapGrade 2 TapKids Hip Hop/JazzPre-Teen/Teen Hip HopSenior Jazz TechniqueIntermediate Jazz TechniqueJunior Jazz TechniqueTeen Lyrical/ContempJunior Contemp/ImprovTeen Tumbling & ConditioningIntermediate AcrobaticsInter. Foundations AcrobaticsFoundations Acrobatics BFoundations Acrobatics ATiny Tumblers

ADULT PROGRAM: check all that apply
Adult Hip Hop/GrooveTeen/Adult Modern & ContemporaryAdult TapAdult BalletAdult Cardio Cabaret

COMPETITIVE PROGRAM (by audition): check all that apply
Competitive AcrobaticsAdult Competitive CrewSenior Competitive LyricalIntermediate/Senior Competitive LyricalSenior Competitive JazzIntermediate Competitive JazzOpen Competitive Broadway JazzSenior Competitive ContemporaryIntermediate Competitive ContemporaryJunior Competitive Contemporary

ELITE, INTENSIVE & COMPANY (by invitation): check all that apply
Elite Dance ProgramIntensive Dance ProgramCompany Dance ProgramCompany/Intensive CombosModern Associate

Photo Permissions:

I give permission to allow photographs and/or video to be taken of my child for instructional, promotional or performance purposes:

YesNo

I give permission for my child’s photograph and/or video to be released for promotional, recognition or performance purposes (newspaper, newsletter, CAD website, CAD Facebook page, Instagram and TIK TOK):

YesNo

Waiver

I have read and accept all Coast Academy Policies:
Etiquette; Dress Code; Fee Policies
I understand that neither Julie Izad, nor her teaching staff will be held responsible in the unlikely event of an accident, illness, or injury at 5645 Wharf Avenue, Sechelt or at any other premise where we may be dancing/performing. I also understand that fees are to be paid in full in order for students to attend classes or participate in any performances. I do not hold the academy responsible for lost or stolen items. I have read your new CAD Covid-19 safe operations policy and understand I am not to bring my child to dance if and when they are experiencing flu-like symptoms.