Student Registration Form

Student First Name*

Student Last Name*

Date of Birth*

Gender* FemaleMale

Street Address*

City*

Postal Code*

Phone*

Parent or Adult Student Email*

Children/Teens:

Parents or Guardians names

Parent's Cell #'s

Academic School

Student Email

All Students:

Other family members in this academy

New student this year?* NoYes

# Years of dance experience*

Desired classes:

CHILD/TEEN: check all that apply (Competition classes by audition only)
Ballet 1 (most advanced)Ballet 2Ballet 3Ballet 4Advanced 1 BalletIntermediate BalletGrade 6 BalletGrade 5 BalletGrade 4 BalletGrade 2 BalletGrade 1 BalletPrimary BalletPre-school BalletPointe 3Pointe TechniqueTeen Ballet & TechniqueAdvanced 2 Modern (most advanced)Advanced 1 ModernIntermediate ModernGrade 6 ModernGrade 4 ModernGrade 3 ModernGrade 1/2 ModernGrade 6 TapIntro TapAdv 1 TapSilver TapIntermediate TapKids' Hip HopPre-Teen Hip HopTeen Rec Hip HopHip Hop TechniqueJunior Tech JazzInter Jazz TechniqueInter/Senior Jazz TechniqueInter/Senior Technique/improvJunior Song & DanceJunior ContemporaryTeen Commercial JazzTeen Contemporary JazzTeen Partner DancePre-school Creative DanceTiny TumblersFoundations acrobatics AFoundations acrobatics BIntermediate Foundations AcrobaticsPrep TNT (pre-comp)Teen TNT ATeen TNT BIntensive/company Barre & StretchCompetitive Junior/Inter JazzCompetitive Inter/Senior JazzCompetitive Inter ContemporaryCompetitive Senior ContemporaryOpen Competitive Performance JazzInter Comp LyricalInter/Senior Competitive LyricalCompetitive Inter Hip HopCompetitive Senior Hip Hop

ADULT: check all that apply (Competition classes by audition only)
Adult Cardio CabaretAdult TapAdult Sassy JazzAdult BalletAdult Hip Hop/GrooveAdult Competitive Street Jazz

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):

YesNo

Waiver

I agree to the following:
I have read and accept all Coast Academy Policies. I understand that neither Julie Izad, nor her teaching staff will be held responsible in the unlikely event of an accident 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.