Registration

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Urban Groove 2018
- Registration
- Workshop Schedule & Instructors

CONTINUAL SURRENDER

REGISTRATION FEES

Full workshop rate:
$20 ($15 for all Kids Can Dance members)

Other rates:
$10 per workshop

View schedule and instructors here

*Must wear non-marking shoes

Ages: 6-14

Payment Options:
- Cash/Cheque payment on May 12
- Credit card payment - call Harvest City Church (306) 569-1935
- Mail cheque

Cheques can be made payable to "Harvest City Church" and sent to:

Harvest City Church
C/O Urban Groove
2202 8th Ave North
Regina, SK
S4R 7T9

URBAN GROOVE REGISTRATION

* Indicates required field

Name *

First

Last

Address *

City *

Postal Code *

Province *

Phone Number *

Email *

Emergency Contact Name *

Emergency Phone Number *

Health Card Number *

Gender *

Male Female

Age (6-14 years) *

Dance Studio (if applicable) *

Registration Type *

Full Workshop ($20) Full Workshop ($15) - Kids Can Dance Members Only One workshop only ($10)

Attending part of the day? Check off the workshop you plan on attending. *

Workshop #1 (1:15 pm - 2:05pm) Workshop #2 (2:10 pm - 3 pm)

How did you hear about the workshop? *

Parent/Guardian Release

I, the undersigned, being 18 years of age or older, on behalf of the student named above, understand that Urban Groove, the instructors, and Harvest City Church are not liable for personal injuries or loss of, or damage to, personal property. I understand that participating in dance classes involves the risk of physical injury. I therefore assume all risks involved in the participation of Urban Groove whether it be I, or my participating minor child. I exempt, release and indemnify Urban Groove, the instructors, including assistants and volunteers and Harvest City Church from any and all liablility claims, demands or causes of action whatsoever from any damage, loss or physical injury to myself or my participating minor child. I understand that each student may decline to participate in any activity. By signing below, I am acknowledging that I have read and agree to be bound by all of the rules and regulations stated here.

I have read the liability waiver and fully understand and agree to its terms *

Yes No

Signed (Please type full name of parent/guardian if registrant is under 18 years of age) *

Photo/Video Consent *

Yes No

I hereby grant permission to Urban Groove representatives, to take and use: photographs, video and/or digital images of me for use in promotional materials and/or social media. These materials might include printed or electronic publications, web sites, or other electronic communications.

Submit