Anastasia February 9 & 10 2018

Ballet Jörgen Class Registration Form

Please complete the form below for student enrolment in one or both of the Ballet Jörgen sessions. Questions? Contact our box office at 604.981.6335 or by email at, Monday through Friday from 1-6pm.

Student Information
Student Name *
Student Name
Enrolled Sessions *
Please indicate the sessions in which the student is registered.
Dance Level *
Parent/Guardian Contact Details
Name *
Contact Phone *
Contact Phone
Alternate Contact Name *
Alternate Contact Name
Alternate Contact Phone *
Alternate Contact Phone
INDEMNIFICATION & RELEASE I hereby represent that my child has no physical restriction, which would prohibit his/her participation in this event I, the undersigned parent/ guardian, on behalf of myself, my heirs, legatees and assigns, agree to indemnify, save and hold harmless Kay Meek Centre, Ballet Jörgen or any of their representatives, employees, volunteers, or assigns for my child’s health, safety, or any injury and/or disability arising out of or resulting from the event. PHOTO RELEASE I hereby release the right to use any photo and video materials' of my child for promotional, instructional and educational purposes for programs which operate under Kay Meek Centre without limitation on time or frequency.  I understand that these photos may be used in program brochures, photo displays, and on the Kay Meek Centre website and on social media. We will not release any names or give any other information out regarding the identification of individuals in the photos without prior consent.
Acknowledgement *