Registration

Entry deadline: Monday July 7 2008

Name: _________________________________________________                 

Address: _______________________________________________             

City: __________________________________________________                   

Tel:______________ Email:________________________________  

Birthdate:____________ Age: _________     

Dance level: ______________
              
Dance School:____________________________________           

Dancer Registration Fee: $__________

Non- Dancer BBQ Fee: $_________         

Total fees: $______________

Payment:  Cheque_________  Cash ____________                       
(Canadian cheques or money orders only) 

Mail entry with full payment to:
Pacific Interior Pilates Inc.
#102- 546 Leon Ave.,
Kelowna, B.C.              
V1Y 6J6                          

Any health problems that we should be aware of?

Doctor’s name:_____________________________________________   

Doctor’s telephone: _________________________________________          

I hereby waive all claims for injury or loss to person or property during participation in Summer School at the Pacific Interior Dance & Pilates and release, discharge and save harmless, promoters, directors, principals, agents and employees from any liability for injury damage or loss to property or person whatsoever, which may be caused by any act or omission of these.

Name of Parent or Guardian: _____________________________________________

Parent or Guardian signature: _____________________________________________