Student Registration Form

Student First Name*

Student Last Name*

Student Age*

Date of Birth e.g. 1991-12-31*

Sex*FemaleMaleNon-Binary

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:

How did you hear about us? We would be grateful for your feedback. Please let us know if you found us through word of mouth, social media (Instagram or Facebook), a local billboard, the newspaper, a search engine (Google, Yahoo, etc), or from any other source:

Desired classes:

GENERAL PROGRAM: check all that apply
Parent & Tot Dance 2-3Pre-School Ballet & Creative Dance 3-4Pre-Primary Ballet 4-5Primary Ballet 6-7Grade 2 Ballet 7-9Grade 4/5 BalletGrade 6/Inter Foundation BalletAdvanced One BalletAdvanced Two BalletJunior Ballet Technique 9-12Intermediate Ballet Technique 12+Senior Ballet TechniquePre-Pointe & Foot ConditioningIntermediate PointeSenior PointeGrade 1/2 ModernGrade 2/3 ModernGrade 4 ModernGrade 5/Bronze ModernGrade 6/Inter Foundation ModernIntermediate ModernAdvanced One ModernAdvanced Two ModernGold Jazz TechniquePlatinum Jazz TechniqueDiamond Jazz TechniquePrimary Jazz/Tap 4-6Jr Jazz/Tap 7-9Pre-Teen Jazz/Tap 9-12Advanced 1/2 TapPre-Teen/Teen Contemporary 11+Teen Partner DanceCreative Hip Hop 4-6Kids Hip Hop 6-8 WednesdayKids Hip Hop 5-8 FridayJr Hip Hop 9-11Inter Hip Hop 11+Senior Hip HopTiny Tumblers 3-5 2:30-3:15Tiny Tumblers 3-5 3:30-4:15Foundations Acro AFoundations Acro BFoundations Acro CIntermediate Foundations Acro AIntermediate Foundations Acro BIntermediate AcroTeen Acro

ADULT PROGRAM: check all that apply
Adult Hip HopAdult Jazz/ContemporaryAdult Ballet/Modern

COMPETITIVE PROGRAM (by audition): check all that apply
Adult Competitive CrewCompetitive AcrobaticsPre-Competitive AcrobaticsGold JazzPlatinum JazzDiamond JazzGold BroadwayPlatinum/Diamond BroadwayGold/Platinum Lyrical/ContempDiamond LyricalPlatinum ContemporaryDiamond ContemporaryPlatinum/Diamond Ballet

INTENSIVE & COMPANY: check all that apply
Intensive Dance ProgramCompany Dance ProgramIntensive & Company ProductionsModern AssociateAssociate Third Year

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 the 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.