Student Information

Student’s Name:	Date of Birth:

Parent/Guardian Name:

Email Address:

Primary Phone:

Emergency Contact Name and Phone:

Name of Person responsible for paying fee:

Legal Release and Policy Acceptance (please initial)

I/we have read, understand and agree with the Waiver of Liability (see bassburn.ca)
AND

I/we have read, understand and agree with the venue protocols (see BRCACalgary.org, Yogamcc.com, and ecspaces.com)
Virtual unlimited excluded

(I am not a robot) Signature / Responsible Party	Date:

Classes

Class Name	Date(s)	Time

Registration Fee (Includes tax and admin fee):

Email transfer to: Karenberry@kmotion.ca
Refundable with 1 week notice of cancelation. 50% refundable up to 24 hours notice of cancelation

1. BassBurn Dance Fit –

Full session: $100/10 classes (interchangeable between both weekly classes and virtual)
Immerse Trial: $44/4classes
Drop In: $12, (‘Bring a friend’ $10 each)
Virtual Unlimited: $55/10
2. Tiny Ballet 4-5 yrs $75
3. Hip Hop 6-8yrs $80