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) *

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 *

I understand and agree to pay the registration fee

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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