Summer Registration

Summer Registration

Please fill out this form carefully to register. Online payments are temporarily suspended while we upgrade our online payment system. Please pay for our summer programs at the studio when you bring your dancer or contact the studio by phone or in person to register.
How did you hear about us?*
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
E-mail*

Terms & Conditions*

I do not hold Premiere Dance Cobourg or their instructors and staff liable for any type of injury, damages, or for lost or stolen items.I agree to comply with all Dress Codes and Poilicies & Procedures as set out by Premiere Dance Cobourg.I give permission to receive email messages and for videotaping and photography by Premiere Dance Cobourg and the company that they hire.I give permission for my child's photo and name to be used in advertisements and promotional materials.I acknowledge and accept that I am not allowed to videotape or record performances without written permission from Premiere Dance Cobourg.I acknowledge that I am responsible in making a payment within 5 days for my spot to be held in the camp.
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