Class Registration — HCPA — Harriet Chung Performing Arts

Student Registration Form

Student Name

First Name

Last Name

Date of Birth

YYYY

Gender

Home Phone #

Country

(###)

###

####

Cell Phone #

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

OHIP #

Any Medical Conditions?

Parent Contact Information

Parent/Guardian #1

First Name

Last Name

Cell Phone

Country

(###)

###

####

Parent/Guardian #2

First Name

Last Name

Cell Phone

(###)

###

####

Program Information

Which terms would you like to register for?

Indicate seasons and year (example: Fall 2020, Winter 2020, and Spring 2020)

Program/Class #1

Provide program/class name and total fees

Program/Class #2

Provide program/class name and total fees

Program/Class #3

Provide program/class name and total fees

Combo Classes

Provide program/class name and total fees

Total Fees

Performance Fee: $30 per student (payable annually). Please refer to Fee Schedule Chart. For all payments in cheques, please add 13% HST to the total. Payable to "Harriet Chung". All payments can be submitted in-person at the studio.

Terms of Agreement

As a student of Harriet Chung Performing Arts, I/We understand that photographs and/or videos of myself and/or my likeness may be used for promotional purposes. My/Our submission of this form, gives permission to Harriet Chung Performing Arts to use such photography and/or videos at their sole discretion. By submitting this form, I acknowledge having received a copy of the studio policies and agree to abide by the terms therein. Waiver – The student on this application and his/her parents/guardians agree that Harriet Chung Performing Arts, shall not be held responsible for any injury, loss or damage whatsoever occurring to the participant while he/she is in attendance at Harriet Chung Performing Arts’ programs or including while he/she is within the premises occupied by Harriet Chung Performing Arts. I/We acknowledge acceptance of the terms of the agreement. I/We consent to his/her or my attendance on the terms of this waiver of liability or in the case of a guardian or a person under 19 years of age, grant our consent to the terms of this waiver.

Do you agree to the terms listed above?

Yes, I/We understand and agree to all the Terms of Agreement listed above.

Student Registration Form

Contact Us

WebSite Menu

Follow Us