Registration Form

New student
Registration form

Please take a moment to read and complete ALL required fields.

Student Information

* Indicates required field

Name *

First

Last

Sibling Name *

First

Last

Gender *

Sibling Gender *

Date of Birth (MM/DD/YY) *

Age *

Sibling Date of Birth *

Sibling Age *

Parent Information

Parent 1 Name *

First

Last

Parent 1 Email *

Relation *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent 2 Name *

First

Last

Parent 2 Email *

P2 Relation *

P2 Phone Number *

Parent 2 Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Information

Emergency Contact Name *

First

Last

Does the student have any medical conditions the instructor should know about? *

Emerg. Phone Number *

Enrollment Acknowledgment

Class Hours Per Week *

Starting Date (MM/DD/YY) *

Acknowledgment:
By initialing below I hereby acknowledge that:
a. I understand that to terminate classes, a written cancellation notice must be made 30 days prior to next payment date in order to avoid charges.
b. I received the "Students & Parents Handbook" and a copy of the Academy's "Rules & Regulations" and that it is my responsibility to read, understand and conduct myself according to these documents.
c. I understand that tuition fees must be paid by pre-authorized debit or credit card on the first of every month and are non-refundable.
d. I understand that all holiday/breaks are included in the tuition and cannot be made up.
e. I understand that tuition fees are subject to change.

I understand & agree *

Check here

Parent Initials *

Conditions, Acceptance and Waiver

Responsible party and/or the student understands that students may be injured during the course of training or during an event at Alouettes Academy. Responsible party and/or the student hereby assume the risk of injury and hereby waives any claim for any and all injuries, including medical expenses, which may arise as a result of dance or other training or any incident or accident directly or indirectly arising from any actions related to dance or other training.

I hereby agree that Alouettes Academy/Alouettes Group Corp. can use pictures and videos of the participant's likeness and waive any and all liability for the release of pictures and videos in any advertisement for Alouettes Academy/Alouettes Group Corp.

Students and parents pledge to comply with all rules and regulations of the Academy. We reserve the right to dismiss any student or parent at any time without a refund of their tuition, for any misconduct and/or failure to follow Academy rules and regulations.

I'm al least 18 years of age or more, I have read, understood and agreed to the terms and conditions of this agreement.

I understand & accept *

Check here

Parent Name *

Date (MM/DD/YY) *

If other, please specify *

Submit

New student Registration form

Student Information

Parent Information

Emergency Contact Information

Enrollment Acknowledgment

Conditions, Acceptance and Waiver

New student
Registration form