Student Registration Form
Student Details
Last Name:
First/Middle Name:
Gender:
Male
Female
Date of Birth:
Languages Known:
Punjabi
Hindi
English
Other
Any Allergies:
Any Medication or Medication History:
Previous Education in Music/Dance
Interested in stage & TV shows?
Yes
No
Contact Details
Address:
City:
Province:
Ontario
Quebec
Nova Scotia
New Brunswick
Manitoba
British Colombia
Prince Edward Island
Saskatchewan
Alberta
Newfoundland & Labrador
Postal Code:
Country:
Canada
India
Home Phone No.:
Cell No.:
Email:
Family Information
Father's Last Name:
Father's First/Middle Name:
Permission to pick up:
Yes
No
Mother's Last Name:
Mother's First/Middle Name:
Permission to pick up:
Yes
No
Emergency Contact Details (Other than parents if any)
Contact Name
Relationship with Student
Phone No.
Cell No.
Permission to pick up:
Yes
No
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I agree to the
Terms and Conditions
Terms and Conditions:
Parent/Guardian agree that Aikam Academy or any of its officials will not be held responsible or liable for any injuries, accidents or lost items at the academy.
This registration cannot be accepted unless signed by Parent/Guardian upon their arrival to the Academy.
No refunds will be issued after first class.
Aikam Academy or Incorporated Body specified on this form permitting me/our child to participate in the association, we hereby promise to indemnify and save harmless the Aikam Acadmey and its members from and against all claims, demands, actions and proceedings, by whomsoever made or brought, in respect of any costs, expenses, loss, damages or injury including death arising by reason of or in connection with my/child's participation in the said activities and hereby release and forever dischagre the Aikam Academy, it's teachers and all it's employees and servants and, Academy or Incorportaed body and its members from against all claims and demands whatsoever which we, our child, our or his/heirs, executors, administrators or assigns, can share or may have by reason of my/our child's participation in such activities, or by reason of the provision of medical care to me/him/her.
Aikam Academy does not have an accidents insurance policy. It is therefore recommended that all registrants in the activity obtain their own accident insurance coverage.
Aikam Academy reserves all the rights for all visual and audio recordings done by the students.