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Sarnia Ballet School
1200 Lambton Mall Road, Unit 3/7
Sarnia, ON
Dancer's Information
First Name
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Last Name
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Gender
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M
F
Birth Date
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+
Parent / Guardian Information
Relationship to Dancer:
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Mother
Father
Guardian
First Name
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Last Name
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Address 1
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Address 2
City
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Province
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Postal Code
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Mother's Cell Phone
Father's Cell Phone
Home Phone
Email Address
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Emergency Contact Person
Emergency Contact Phone Number
Allergies or medical conditions
PARTICIPANT LIABILITY WAIVER: The Sarnia Ballet School has provided a safe environment with a well-trained staff. As a participant or participant’s parent/legal guardian, I understand that by participating in any dance class, workshop, rehearsal, or performance, there is a possibility of physical injury. I therefore agree to assume all risks of any such injury that might occur during any classes, rehearsals, or performances on or off the premises of Sarnia Ballet School. I agree to waive any and all claims I may have arising out of or connected with, or in any way associated with the activities of The Sarnia Ballet School. I hereby fully release and discharge The Sarnia Ballet School, its owners, employees, assistants, volunteers, guest artists, and instructors from any and all claims from injuries, damages, or loss which I or my minor child may have or which may occur as a result of participation in The Sarnia Ballet School activities. I authorize The Sarnia Ballet School to use RECITAL or CANDID classroom photos of my child for promotional and marketing purposes including website. I accept the terms of this liability waiver *
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Yes I agree
Class Selection
PROGRAM SELECTION
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6 Week Little Magic Train (begins Sat. Sept. 10)
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