Registration Information

Full Name

Phone

Address

City

Province British ColumbiaAlbertaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

Postal Code

Age

Email

Date of Workshop

Location of Workshop

Please list previous hip hop dance experience

Please send my confirmation by  Mail Email

Join our mailing list?  Yes No

Registration Fees (Per Workshop)

Regular Rate : $40.00.00 per person

Early Rate: N/A

Single Class Rate: $15.00 per person

Day-of registrations are subject to capacity. To avoid disappointment please register prior to workshop date.

Registrations are non-refundable. Cancellations may be credited towards another workshop.

Method Of Payment

Please make all money orders and cheques payable to "CORE Revelation Productions".

I am enclosing a money order in the amount of: $

I am enclosing a cheque in the amount of: $

Discount Code

All registrations will be sent confirmations via email or mail, depending on your previous choice. Please allow 2 weeks for confirmation.

Additional Information

Emergency contact name(s) and relation:

Emergency contact number(s):

Do you have any medical conditions/allergies we should know about?

Liability Waiver

I, the undersigned, being 18 years or older, on behalf of the student named above, understand that CORE Revelation Productions and the instructors thereof are not liable for personal injuries, loss of or damage to, personal property. I understand that participating in dance classes involves the possibility of physical injury. I therefore assume all risks involved in the participation of Coreify Workshops presented by CORE Revelation Productions, whether it be I, or my participating minor child. I exempt, release and indemnify CORE Revelation Productions and the faculty thereof, including assistants, volunteers and administrative assistants from any and all liability claims, demands or causes of action whatsoever from any damage, loss or physical injury to myself or my participating minor child. I understand that each student may decline to participate in any activity.

By choosing "Yes, I Agree" below, I am acknowledging that I have read and agree to be bound by all the rules and regulations as stated on this registration form.

Yes, I Agree

Today's Date

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