Poltava School of Ukrainian Performing Arts 2021-2022
Class *
* Returning Students: Please refer to the registration information provided via email and select the class below that was stated in the email. *New Students: Please refer to the age brackets outlined in detail on our website and select appropriate class below. *Age categories are based on child's age as of December 31. *For all class information, please contact: poltavaschool@gmail.com
Child's Full Name *
Child's Gender *
Child's Birth Date (DD/MM/YEAR) *
Street Address *
City *
Postal Code *
Home Phone Number *
Medical Information
Please list any medical conditions or allergies your child may have that we need to be aware of.
Parent/Guardian *
Primary Contact
Please provide your address if it is different then the one provided under the child's information.
Email Address *
Cell Phone *
Secondary Contact
Please provide your address if it is different then the one provided under the child's information.
Email Address
Cell Phone
Bingo *
Bingo is a very important part of the organizations fundraising income. We require all families to participate in this to ensure that we will have enough workers for the entire cultural season. Please check off one of the following boxes.
Fundraising *
The Poltava School of Ukrainian Performing Arts has standard fundraising events throughout the year that each family is required to participate in. 1. Grey Cup Pool Tickets and 2. A minimum of 2 shifts worked at Mosaic. Please contact the Poltava School if you have any questions or concerns.
Email Address Consent *
The Poltava School of Ukrainian Performing Arts may need to share your address with other members and families of the dance school for newsletters, bingo and other school related communication. It will not be shared with anyone outside of the organization.
Photography and Film Authorization *
Cancellation Policy *
The Association of United Ukrainian Canadians/Poltava School of Ukrainian Performing Arts reserves the right to cancel classes due to insufficient registrations or other unforeseen events. If this occurs, participants will be given every opportunity to transfer into another class or full refunds will be issued.
Refund Policy *
There will be an administration fee of $25 charged for all refund requests prior to the start of the first day of classes. No refunds will be issued after the start of the program except for medical reasons (Doctor’s note required) or class cancellation.
Costume Policy *
All costumes are provided by the AUUC Poltava School of Ukrainian Performing Arts. Students/Parents are responsible for full costume replacement price in the event of major damage and/or loss.
Class Attire *
The dance school has standard class attire please see our website for updated class attire.
School Decorum *
• Students are requested to arrive five to ten minutes prior to class time. Students arrive in proper dance attire for all classes and follow detailed COVID procedures provided via email and posted at the Ukrainian Cultural Centre.• Students should be picked up promptly after class.• No food, drinks (except water) or gum is allowed in class.• If a student will be absent from a class it is the parents or guardians responsibility to inform the teacher or the school via email at poltavaschool@gmail.com. Please include your child’s name and dance group. • Students are expected to clean up after themselves and treat the waiting areas with respect. Noise and inappropriate behavior will not be tolerated.• Students are expected to remain quiet during class instruction. Please treat your teacher with the utmost respect, as in turn they will do the same for you.• For the safety of all concerned, jewelry (earrings, necklaces, watches, etc.) is not allowed.• All students must take full responsibility for any personal items brought to the studio. The Poltava School will not be responsible for any lost or stolen items.• Disrespectful behavior towards any staff members or students will not be tolerated. Students or parents behaving in this manner may be removed from the school immediately with no refund to fees.• Parents – please advise the school administrator of any administrative, personal, or medical concerns as soon as possible.• Parents – please email any other questions or concerns to poltavaschool@gmail.com.
Minimizing COVID and other Infectious Disease Risks *
The Association of United Ukrainian Canadians Poltava School take the present situation seriously and have been working closely with health professionals to minimize risk to all students, instructors, parents and volunteers. We are following all COVID requirements and policies outlined by the Saskatchewan Health Authority including increased hand washing, increased sanitation between classes, hand sanitizing stations, entrance and exit in building, class size requirements, etc.Please see detailed COVID procedures provided via e-mail and posted within the Ukrainian Cultural Centre.
Acknowledgment of Inherent Risk *
I understand that the participation of my son/daughter/ward (hereinafter the “Participant”) in dancing and any other activities incidental to the activity (hereinafter the “Poltava School”) is voluntary, and involves inherent risk during participation, including the risk of possible accidents, physical injury, or exposure to the COVID-19 virus or other infections or infectious diseases as a result of attending and participating in the Poltava School. I freely accept and fully assume all such risks, dangers and hazards, including but not limited to personal injury, disease transmission, death, property damage or loss, resulting from the participation of the Participant. I have carefully considered the risks involved, and I have full confidence that reasonable precautions will be taken to ensure the safety and well-being of the Participant.
Waiver *
On behalf of the Participant and for myself and our respective heirs, executors, administrators, successors and assigns, I do hereby waive, release, and forever discharge Association of United Ukrainian Canadians, the AUUC Poltava School of Ukrainian Performing Arts (hereinafter “Poltava”) and their respective officers, partners, agents, employees, servants, representatives, volunteers, instructors, successors and assigns (the “Representatives”) of and from any actions, causes of action, complaints, demands and claims or any recourse whatsoever (“Claims”) that I have or may have in the future in any way connected with the Participant’s participation in the Poltava School contemplated herein, whether in law or in equity, in respect of personal injury, illness or disease transmission, loss of life, or property damage of any kind or nature, and I do hereby discharge Poltava and its Representatives from any such liability. Acknowledgement: I am aware of the nature and effect of this Assumption of Risk and Waiver and I fully understand all of the terms and conditions above. I understand that I have given up substantial rights by signing this Assumption of Risk and Waiver and I am signing it freely and voluntarily without inducement.Parent/Guardian: I certify that I am the parent or legal guardian of the Participant named below and that I am entitled to his or her custody and control. I understand the aforesaid inherent risks that could arise from these activities, I grant permission for my son/daughter/ward to participate in the Poltava School and other activities incidental thereto and I execute this Assumption of Risk and Waiver on behalf of myself and my son/daughter/ward.
How did you hear about us.
Clear selection
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy