Summer Fun Camps 2021
Student Name (First and last)
Health Concerns/Limitation
Summer Fun Camps 249+tax weekly (select weeks)
July 12-16 July 19-23 July 26-30
July 5-9
August 3-6 (4 days 199+tax)
August 9-13 August 16-20 □ August 23-27
Use this space for additional notes
Preferred Drop off (between 8:30 & 9:15am) Preferred Pick up (between 3:45 and 4:30pm)
Contact # 1 First Name
Last Name
Relationship to Student
Primary Phone #
Cell #
Work #
Email Address: *This will be used for communication and e-payment receipts, please print clearly
Contact #2 First Name
Last Name
Relationship to Student
Home/Primary Phone #
Cell #
Work #
Email Address:
Postal Code
Emergency Name (Other than above)
Relationship to Student
□ I have read and will abide by the COVID19 protocols and camp waivers.
□ I agree to abide by all rules, regulations and conditions contained herein or which may be posted from time to time.
□ I agree that all exercise and use of any and all facilities/services are undertaken by member at his/her sole risk and responsibility and member
further agrees that the Academy shall not be liable for claims, demands, injuries, damages or actions. Member expressly and forever releases the
Academy, its management, employees, directors or instructors from all claims, demands, damages, actions by myself, my children or dependants, by
reason of the use of any and all facilities.
□ I understand the REFUND POLICY: The camp fee is non-refundable except where MDA cancels a camp or limits enrollment based on
limitations imposed due to COVID19. Camp deposit of $100 is due with registration. Balance is due Thursday prior to camp.
□ I will pay all fees on the due date. A $30.00 service charge will apply for returned cheques. Late fee of $10+tax will apply to overdue accounts.
MDA reserves the right to cancel any class or camp by crediting or refunding the initial fee and any unused dues.
Signature: ____________________________________Date:________________
Payment Information:
□ E-transfer to (include students name in the message)
□ In person (Debit, Credit, Cash)
Staff Initial & Date
Visa or Mastercard: Maritime Dance Academy may bill my card for:
□ All future payments □ Camp payments only
Name on Card
Card Number
Card Expiry
Please read page 2. An email will be sent a few days prior to camp confirm your registration and will include information about the camp and any
special instructions related to the health and safety guidelines we will be following during the week.
Summer Fun Camps
Located at 998 Parkland Drive, Halifax
Email registration to
Maritime Dance Academy & Theatre School Camp Waiver
I understand that all Maritime Dance Academy programming includes physical activity in the form of a variety of sports
and recreational activities. I agree that Maritime Dance Academy will not be held liable for any injury to my child, or loss or
damage to my child’s personal property. I understand that all items left behind may be thrown away, including but not limited to,
clothing, shoes, water bottles, and dancewear.
I have read and will abide by Maritime Dance Academy’s COVID19 Protocols. I understand and accept the risks
involved with participating in Camps during the COVID19 pandemic.
In consideration of my child being allowed to participate in Maritime Dance Academy programming, I, the
parent/guardian of the child, on my own behalf and on behalf of my child, waive all present and future claims against Maritime
Dance Academy, and its directors, coaches, employees, officers, servants, representatives, volunteers, insurers and agents (and
their respective successors and assigns) (collectively, the “Releasees”) and hereby release the Releasees from and against all
liabilities, claims, actions, demands, costs and expenses relating to injury, illness, death, loss, damage to person or property or
loss of property, foreseen or unforeseen, howsoever caused (including negligence of any one or more of the Releasees), arising
out of or in connection with my child’s participation in Maritime Dance Academy programming.
I, on my own behalf and on behalf of my child, also agree to indemnify the Releasees for, on account of or by reason of
any claim advanced against any of them, or any loss or damage sustained by them, arising out of my child’s participation in
Maritime Dance Academy programming.
In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached in an
emergency situation, I hereby give permission to licensed emergency and health care personnel to provide treatment/services
necessary to maintain the health of my child. In the event of medication, medical advice, treatment and/or equipment are
required; I agree to accept financial responsibility for fees in excess of provincial and or private medical insurance. I agree that
the medical information provided to Maritime Dance Academy on the program registration form may be disclosed to such
emergency and health care personnel. In the event of illness, accident, emergency, or any other circumstance requiring medical
treatment, such treatment may be procured for the participant without legal or financial obligation to Maritime Dance Academy.
I have read and understood the terms of this agreement and BY ALLOWING MY CHILD to participate in Maritime
Dance Academy programming; I am voluntarily agreeing to abide to these terms. I confirm that the participant I have registered
on this form is physically and mentally able to participate in all Maritime Dance Academy programming. I agree to the terms and
conditions outlined in this Guardian Permission/Liability Waiver. I agree that any photos or videos taken of my child by Maritime
Dance Academy during this camp can be used for promotional purposes.
Acceptance of this waiver is indicated by the checking the box on the registration form.
Summer Fun Camp is located at 998 Parkland Drive, Halifax.
Summer Fun Camp scheduled activities: 9:00 4:00 daily.
Early drop off 8:00 am & Late pick up until 5:30pm available must be indicated on registration form.
Priority will be given to week-long fun camp attendees, however daily opportunities may be available as
space allows.
An email will be sent mid-week prior to camp with details about what to expect, what to bring, and a
reminder/update about our Covid protocols.
Lunch Menu will be emailed prior to camp for advance orders. Lunch may be ordered up to the Monday
morning of your camp week.
Please note the contact number for fun camp is 902-443-3144.