Impact Dance Co. Registration Form Tiny Tot 2026-27

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Please fill out this form to register your child for the 2026-27 Dance Season. You will be contacted through e-mail once the form has been received and processed. If you have any questions please contact Impact Dance Co. email impactdancehumboldt@outlook.com If you need any information about any of the classes offer we encourage you to look at the website for a detailed description of each class offered at Impact Dance Company.
impactdancehumboldt.com
Please fill in a separate form for each child you are registering.

Please note that IDC will be charging GST on all fees associated with classes, costumes, etc.

*New Tiny Tot Dancers receive ONE FREE MONTH of classes for both ballet & acrodance*

Registration Promo - We are offering a special promotion for all Tiny Tots (ages 2 & 3) . Find us on Facebook &/or Instagram, share our tiny tot post and tag a friend - Your dancers name will be entered into a draw for a FREE bodysuit, FREE ballet skirt AND FREE ballet slippers for class! Make sure to do this by JULY 30th to qualify!

Tiny Tot Classes are for children age 2&3

First and Last Name of Dancer *

Birthdate -- PLEASE NOTE - (MM/DD/YYYY) *

Age (As of Dec. 31st 2026) *

Parent/Guardian First and Last Name *

Mother Phone Number

Father Phone Number

Email Address (add all email address's you would like correspondence sent to) *

Mailing and Physical Address *

Please indicate which classes you are registering your child for. *

Tiny Tot Ballet MONDAY 5:00-5:30

Tiny Tot Acrodance MONDAY 5:30-6:00

Required

Refer a Friend and Save!

Already part of the Impact family? Invite a friend to join us. When a new dancer registers and lets us know you referred them, both families will receive 50% off the registration fee.

(Below - let us know if you referred someone OR if you're new please let us know who referred you!)

Do you give permission to use photos of your child for promotional, online and/or print purposes? *

Yes

Please read and check the box that you understand and agree with Impact Dance Company Studio Contract *

All Statutory Holidays will be observed by the studio, unless otherwise notified. It is the Parents responsibility to keep informed of studio activities via newsletters/emails and website.

Proper dance attire will be expected of each dancer.

Students are to attend class regularly (no refund for missed classes).

Class tuition can be paid monthly (9 payments) OR pay quarterly(Sept. 1, Dec. 1st, Feb. 1st and May 1st.) OR 2 equal payments (Sept. & Feb.)OR pay in full at Registration. Payments can be made using E-transfer, Cheque, Cash or Direct Deposit

1 month written notice must be given upon termination of classes. If a dancer drops a class after November 1st payment is required for competition fees and costume fees. NO EXCEPTIONS

A registration fee of $40.00 will be charged upon registration for each dancer. NON REFUNDABLE.

IMPACT DANCE CO. will not accept responsibility for any accident, injury, or loss of personal property.

Account balance needs to be up-to-date in order to be handed costumes when they arrive.

Disruption and disrespect during class and/or break time may result in the student being excluded from the class as well as parents will be notified.

NEW TINY TOT DANCERS You will receive ONE FREE MONTH of classes. At the end of September you will be billed for 8 months of classes.

Required

STUDIO Acknowledgement of risk and general release of liability. The following waiver of all claims, release from all liability, assumption of all risks and other terms of this agreement are entered into by me on behalf of the undersigned student (the 'student') with and for the benefit of the Instructors Terralea Armstrong & Kylie Redl-Gosselin, operating as Impact Dance Company, together with their officers, directors, agents, employees, successors, and assigns (collectively 'Instructors'). In consideration of the Instructors allowing the Student to attend the Studio premises, participate in dance lessons, competitions, and all associated activities (collectively the 'Dance Activities') I agree: * *

1. The inherent nature of Dance Activities include but is not limited to contact and non-contact poses, tricks, lessons, classes, training, use of facility programs and services provided to the Student by the Instructor(s).

2. I am aware that there are inherent dangers, hazards and Risks ('Risks') associated with the participation in Dance Activities. I am aware that the Risks include but are not limited to injury from physical contact with other students, instructors or equipment, performing a skill incorrectly or potentially dangerous obstacles, conditions on the floor or in the vicinity of Students during Dance Activities. I understand that the Risks are relative to the Students state of fitness or health (physical, mental, and emotional) and to the awareness, care and skill with which with the student conducts hum/herself in Dance Activites.

3. I freely and fully assume and accept all responsibility for all Risks and possibilities of personal injury, loss, or property damage arising from, associated with, or in any way related to the Student's participation in Dance Activities, or their attendance at the Studio premises, including Risks that are both known and unknown.

4. I agree that although the Instructors have taken steps to reduce the Risk and increase the safety of Dance Activities, it is not possible for the Instructors to make Dance Activities completely safe.

5. I accept these Risks and agree to the terms of this waiver even if the Instructors are found to be negligent or in breach of any duty of care or any obligation to the Student in the Student's participation in Dance Activities, or their attendance at the Studio premises.

6. I and my next of kin, executors, administrators, as well as the Students next of kin, executors, and administrators (collectively our 'Legal Representatives') expressly agree: (A) To waive all claims that I, the Student or our Legal Representatives have or may have in the future against the Instructors ; and (B) To release and forever discharge the Instructors from all liability for all personal injury, loss, damage, or property damage arising from, associated with, or related to the Student's participation in Dance Activities due to any cause, including but not limited to negligence on the part of the Instructors (failure to use such care as a reasonable, prudent, and careful person would use under similar circumstances).

7. I, the undersigned, confirm that I have had sufficient time to read and understand each term in this acknowledgment and waiver in its entirety, and have agreed to the terms freely and voluntarily. I understand that by checking the box, I am knowingly and willingly agreeing on behalf of myself, the Student, and our Legal Representatives, to release the Instructors, and their principles, owners, officers, agents, and employees from all liabilities and risks incident to the Student's attendance at the Studio and any associated Dance Activities. I expressly intend that this waiver be binding on myself, the Student, and our Legal Representatives.

Required

ACRODANCE LIABILITY

If your dancer is NOT in acrodance please check the TOP BOX. If your child will be participating in ACRODANCE please check all the boxes once you have read and agreed to each statement.

My Child is NOT participating in ACRODANCE

"Acrodance" includes but is not limited to contact and non-contact poses, tricks, lessons, classes, training, use of facility, programs and services provided to the Student by the Instructors.

I am aware that there are inherent and significant dangers, hazards and risks ('Risks') associated with the participation in Acrodance. I am aware that the Risks include but are not limited to injury from physical contact with other Students, Instructors or equipment, performing a skill incorrectly, or potentially dangerous obstacles, conditions on the floor or vicinity of Acrodance completely safe. I understand that the Risks are relative to the Student's state of fitness or health (physical, mental and emotional) and to the awareness, care and skill with which the Student conducts him/herself participating in Acrodance.

I freely accept and fully assume all responsibility for all Risks and possibilities of personal injury, or property damage with the Student's participation in Acrodance. I agree that although the Instructors have taken steps to reduce the Risk and increase the safety of Acrodance, it is not possible for the Instructors to make Acrodance completely safe. I accept these Risks and agree to the terms of this waiver even if the Instructors are found to be negligent or in the breach of any duty of care or any duty of care or any obligation to the Student in the Student's participation in Acrodance.

I acknowledge the Students obligation to inform the nearest Instructor if the Student feels any pain, discomfort, fatigue or any other symptoms the Student may suffer during or immediately after his/her participation in Acrodance. I understand that the Student may stop participating at any time, and has the right to immediately withdraw from any exercise or drill in which the conduct of any party seems beyond the scope of training, makes the Student uncomfortable or which the Student believes will be harmful to him/her.

In addition to consideration given to the Instructors for the Student's participation in Acrodance, I and my next of kin, executors, administrators, as well and the Student's next of kin, executors and administrators (collectively our 'Legal Representatives') agree: (A) To waive all claims that I, the Student or our Legal Representatives have or may have in the future against the Instructors; and (B) To release and forever discharge the Instructors from all liability for all personal injury, property damage with the Students participation in Acrodance due to any cause, including but not limited negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances).

I confirm that I have had sufficient time to read and understand each term in this waiver in it's entirely, and have agreed to the terms freely and voluntarily. I understand that this waiver is binding on myself, the Student and our Legal Representatives.

Required

How did you hear about Impact Dance Company? *

Returning from last year

Website

Facebook

Instagram

Google

Friend/Family

Poster

Other:

Required

Today's Date *

YYYY

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