Uxbridge Dance Registration Form
This form must be complete along with Liability Waiver & Release Form (bottom) AND FULL PAYMENT RECEIVED in order to: participate in, to receive communications about, and for spots in class(es) to be secured. Absolutely NO spots or exceptions will be made. Please fill out ONE Registration Form per family.
Select A Class | Sat June 15 - Sat July 20 2019
$75 For 6 Week Session
TotAcro (beginner) - Approx age 1-2yrs | Sat 9:45-10:30 *guardian participation
TotAcro (some experience) - Approx age 2-3 yrs | Sat 10:30-11:15 *guardian participation optional
Creative Movement - Approx age 3-4 yrs | Sat 11:30-12:15
Creative Movement - Approx age 4-6 yrs | Sat 12:15-1
Child(ren)'s First Name, Last Name, Age
Describe Any Cognitive or Physical Needs of Participant(s)
All prices include HST
45 mins class | $75 @ 6 wks OR $135 @ 12 wks
60 mins class | $85 @ 6 wks
75 mins class | $95 @ 6 wks
Upon submission of your Registration Form, please send full payment by e-transfer to
. Full payment must be received in order to secure your spot in class AND in order to receive communications about class (including the first day & class location). We do not accept payment in any other form. Anyone wishing to withdraw from class must do so by email and a refund will be provided by e-transfer minus any classes participated in and a $5 admin fee. Please ensure our email address is on your safe list! Receipts will be provided digitally when full payment has been received and after the first week of class.
Payment Made to
By e-Transfer for $75
By e-Transfer for $135
Send me a digital receipt to my email (receipts issued after the last day of classes)
Send me a digital Gift Card to my email so I can give the gift of dance!
Liability Waiver & Release Form
LIABILITY WAIVER & RELEASE FORM Thank you for your participation in the Uxbridge Acrobatics Classes at Soul To Sole Dance Inc. In order to participate, you must sign and submit this form online, via email, or on the first day of classes. Please read the following Terms & Conditions: Registration Fees: Fees are non-refundable and non-transferable. Should a registrant become injured or ill prior to the schedule classes or be unable to attend, contact us by email as soon as possible. Classes and fees will not be prorated. Schedule: Soul To Sole Dance Inc reserves the right to change or consolidate class schedule based on the needs of instructors, the number of registrants, venue requirements, or unforeseen circumstances. Soul To Sole Dance Inc makes every effort to adhere to published schedule and should a schedule change be required, we will communicate with registrants by email, web, and social media prior to scheduled classes. Participation Requirements: In order to participate in Uxbridge Acrobatics Classes, participants must be in good physical health, must sign and return this Liability Waiver & Release Form, must make full payment online or in person, must behave appropriately throughout classes so as to ensure a positive and safe environment for everyone. Soul To Sole Dance Inc reserves the right to refuse participation to any registrant who does not meet the requirements outlined in this form and no refunds will be given. Recording Devices: Video recording and photography by participants or observers is permitted inside the venue. Feel welcome to tag @soultosoledanceinc and all instructors on any social media posts. Media Release: In participating in and in signing this Liability Waiver & Release Form you agree to photos and videos of you being used or distributed by Sole To Sole Dance Inc and its agents for media posting, public relations, and advertising. Personal Harm & Injury: In participating in and/or attending any Soul To Sole Dance Inc classes AND in signing this Liability Waiver & Release Form, you agree to release Soul To Sole Dance Inc, the venue/facility, and the respective organizers, directors, instructors, employees, volunteers, and participants from any and all liability (injury, accident, theft), that may result during the workshops and while travelling to and from the venue/facility. You further agree to indemnify and hold harmless Soul To Sole Dance Inc heirs, successors, assigns, executors and administrators against loss from any further claims, demands, or actions. You further agree to fully reimburse Soul To Sole Dance Inc for any losses, damages, or costs Soul To Sole Dance Inc may have to pay as a result of any such action, claim, or demand, including but not limited to attorneys’ fees. Medical release: I acknowledge and agree that participation in Soul To Sole Dance Inc classes subjects me to the risk of physical illness or injury (minimal, serious, catastrophic and/or death) and that I acknowledge that I am assuming the risk of such illness or injury by participating/attending. In the event of such illness or injury, I authorize Soul To Sole Dance Inc to seek medical care for me and hereby release and hold harmless Soul To Sole Dance Inc and participants in the exercise of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred by me for any illness or injury that I sustain during the Soul To Sole Dance Inc classes or travelling to or from them. I hereby warrant that I have read this Liability Waiver & Release Form in its entirety and understand its contents. I am aware that this Liability Waiver & Release Form releases Soul To Sole Dance Inc from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I further acknowledge that nothing in this Liability Waiver and Release Form constitutes a guarantee that the event will occur. I have signed this document voluntarily and of my own free will.
I acknowledge having read and understood this document in full
Send me a copy of my responses.
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