Adult Class Registration Form
Welcome to Difinity Dance registration form. Kindly fill out the application form. Once it is received it will be reviewed and you will be sent a confirmation email detailing your registration details, and if you qualify for subsidy. Once you receive that from us you can send in your registration fees via our secured PayPal and Interac E-Transfer process to: You will automatically receive a digital downloadable receipt and class-pass that you need to bring with your first class only to confirm your identity. This is to create a safe, professional environment for all class participants to engage in.

If you have any questions about this form please contact us or visit our website for more information: P: 204.894-1075- Stephanie Strugar (Artistic Director)
What is your Full Legal Name *
What is your email address? *
What is the best number to reach you on? *
Who would you like us to contact in case of a medical emergency? *
What Program(s) would you like to register for?
Are you over the age of 18? If under, are your parent/ gaurdian able to fill out the registration form? *
Are you able to fill out the Liability Release Waiver that is a mandatory requirement of the registration? *
Do you have any medical conditions that could impair, or affect your ability to participate in the class? If yes, please check all boxes that apply. This is confidential information, and used only by the Instructor to prevent injury and to provide adequate supports to participants during class instruction. You will not be discriminated against for your answers. Depending on the accommodations required we may be able to provide additional support staff or changes to the lesson plans. Our goal is to create a comfortable, safe space for you to enjoy a dance fitness education. *
Do you require subsidy for your classes? A maximum of 30% off the registration can be provided. However we do not have grant coverage or private sponsorship. subsidy is available to those who qualify as long as spots are available in the program(s) you are interested in. *
What is your current income level? Please check one. Please consider your total family income including your spouse, child tax, pension, and any other funding benefits you currently receive. Subsidy percentage provided depends on income level. If subsidy is provided, total registration cost for the program (s) you are registering for must be provided in one payment by paypal or interac e-transfer.A photocopy or picture of your last years income tax must be provided at time of registration by email to: after you have sent in this form. *
What is your preferred payment method you would like us to email your invoice to? *
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