Chaban Regina Registration Form
Please fill out this form completely - one form per dancer is required
Email address *
Dancer's Full Name (First, Last) *
Dancer's Phone Number (xxx-xxx-xxxx) *
Street Address (primary address) *
City/Province/Postal Code *
Dancer's Email *
Dancer Birthdate (i.e., 09/22/2015) *
MM
/
DD
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YYYY
Dancer Age as of September 1, 2020 *
Parent/Guardian (Primary Contact information) *
Parent/Guardian (Primary Address including Postal Code) *
Parent/Guardian Phone Number (xxx-xxx-xxxx) * *
Parent/Guardian Email Addresses *
Parent/Guardian (Secondary Name and Contact Information-if not applicable please state n/a) *
Secondary Parent/Guardian Phone Number (xxx-xxx-xxxx) *
Secondary Parent/Guardian Email Addresses (if not applicable, please state n/a) *
Class - Please select the class you wish to register for. (note: class times may be adjusted during re-opening stage due to COVID-19 guidelines) *
Please select class for number of costumes and applicable costume rental fee *
Registration fee is due and payable by October 15th *
Required
Select Class (credits/post dated cheques) *
Fee Payment Options
We have several convenient options for payment of fees available. Please note that at this time we are requesting payment be made by contactless payment using e-Transfer. If you have any questions please contact chabanregina@gmail.com for details.
Please select the option you wish to use to pay dance fees. *
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