Student Form - Learning Stars Arts Academy

Student Name *

First

Last

Email *

Used for all communications. Please make sure it's correct.

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Date of Birth *

Health Care Card *

Do you have any known health issues? *

Yes
No

Health issues: *

Please describe any known health issues.

Who is filling this form? *

Mother
Father

Mother *

First

Last

Mother Email *

Phone *

Father *

First

Last

Father Email *

Father Phone *

Emergency Contact *

First

Last

Emergency Phone *

Emergency contact relationship to student? *

Must be 18 years old.

Emergency Contact #2 *

First

Last

Emergency Phone *

Emergency contact relationship to student? *

Must be 18 years old.

Registering for *

Gidha & Bhangra (Thursday 4:30pm - 5:30pm)
Gidha/Bhangra/Double Addi Dance (Thursday 5:30pm - 6:30pm)
Gidha/Bhangra/Double Addi Dance (Thursday 6:30pm - 7:30pm)

Subscription Type *

Monthly Plan ($55/m)

Cancel any time with one month's notice.

Total (including GST)

$0.00

Payment *

Card

Name on Card

Studio Terms *

I agree with the Learning Stars Arts Academy's Terms and Rules & Regulations:

1. If the student is absent, there will be no reimbursement for the missed practice.
2. Please provide a water bottle for your child labelled with their name on it.
3. For the student's safety, parents must come into the facility when dropping off and picking up.
4. Students must arrive on time and be picked up on time.
5. Students are expected to be respectful to the instructors and other peers at all times.
6. I grant permission to be photographed/video-graphed by media present at the events and for marketing purposes.
7. I hereby waive and release the staff and coaches of Learning Stars Arts Academy from any and all responsibility for any injuries or illness that may occur on the premises of Learning Stars Arts Academy.
8. I hereby claim my child/participant is physically able to participate in Learning Stars Arts Academy programs.
9. You are signing up for a monthly subscription. To stop monthly payments, you must cancel with a 30-day notice. No refunds are issued.

Student Registration Form

Studio Hours