Summer Camp Registration DANCER Participant Name (First and Last Name) Health Card # Date of Birth (format: dd/mm/yyyy) Participant Age (format: Years Old) Does your child have any special physical or emotional needs we should be aware of? REGISTERING PARENT Registering Parent Name (First and Last Name) Cell Phone Email ASOD Summer Camp Schedule Week Age Class $200Morning $200Afternoon $300Full Day July 11-15 5-8 years Gymnastics 5-8 years Dance 5-8 years Gymnastics & Dance 9+ years Gymnastics July 18 - 22 5-8 years Gymnastics 9+ years Gymnastics 9+ years Dance 9+ years Gymnastics & Dance August 8 - 12 5-8 years Gymnastics 5-8 years Dance 5-8 years Gymnastics & Dance 9+ years Gymnastics August 15 - 19 5-8 years Gymnastics 9+ years Gymnastics 9+ years Dance 9+ years Gymnastics & Dance PAYMENT METHODS Check one: Visa Mastercard American Express E-Transfer Please Note: If you are paying with a credit card, please call 613-623-5938 with your card details after you complete and submit this form. If you are paying by e-transfer, please send your payment to monica@arnpriorschoolofdance.com TOTAL DANCE CLASS FEES DUE Payment due ASSUMPTION OF RISK AND WAIVER OF LIABILITY ELEMENTS OF RISK Understands that the Activities, like all recreational activities, involve risk of serious injury, including permanent disability or death, and severe social and economic losses which might result from participant action, inaction, negligence of others, rules of play, or the condition of the premises or any equipment used thereon. Understands that there may be other risks not known or reasonably foreseeable at this time and that such risks shall be assumed by the undersigned. Understands that the chance of an injury occurring can be reduced by carefully following instructions at all times while engaged in the Activities. ACKNOWLEDGEMENT Understands that as a Participant in the Activities, I am assuming the risks associated with the Activities. ACKNOWLEDGEMENT FOR PARENTS/ LEGAL GUARDIANS Fully understands that the Activities for which I have given permission to the Participant to be involved in may involve personal risk, dangers, and hazards which all participants are required to assume including but not limited to some risk of personal injury caused by physical activity or other participants. Understanding this, I hereby accept on behalf of the Participant all risks, dangers, and hazards as well as the possibility of personal injury or other loss resulting from the Participant’s participation in the Activities. INDEMNIFICATION Agrees to indemnify and save harmless the Arnprior School of Dance, its employees, officials, agents, directors, and volunteers, from any and all liability for injury, death, property damage or any other loss sustained by the Participant as a result of participation in the Activities to any cause whatsoever; including negligence, breach of contract, or breach of any statutory or other duty of care; and Agrees to indemnify and save harmless the landlord and the owners of 394 Russett Drive, Arnprior, for the same. COVID-19 Individuals who have traveled outside of Canada within the previous 14 days or who are sick or who have been in contact with someone who is suspected of having Covid-19 must not use the facilities or attend classes. This access may be withdrawn at any time based on health agency recommendations. In response to efforts to contain the spread of COVID-19 Coronavirus, I am aware that I am using the facilities at my own risk. If at anytime I travel outside of Canada or have been in contact with anyone who is suspected of having COVID-19, I agree to have my family self isolate for 14 days and will not attend activities at Arnprior School of Dance. Arnprior School of Dance has put in place preventative measures to reduce the spread of COVID-19; however, Arnprior School of Dance cannot guarantee that you or your child(ren) will not become infected with COVID-19. Attending any public spaces increases your risk and your child(ren)’s risk of contracting COVID-19. I acknowledge that I have read the above and agree to the waiver of liability, all rules, regulations, terms & conditions. FULL PAYMENT REQUIRED Registration is only complete once full payment is received. Your child's spot cannot be held without full payment. CONTACT US Email: monica@arnpriorschoolofdance.com Phone: 613-623-5938 Studio Address: 394 Russett Drive, Arnprior K7S 3G8 Mailing Address: 204 Campbell Drive, Arnprior Ontario K7S 3G8