Midnapore Kids Registration Winter 2026 Please enable JavaScript in your browser to complete this form.Primary Caregiver/Account Holder *FirstLastRelationship to Registrant(s)I am the registrantMotherFatherGuardian/CaregiverOtherEmail *Phone *Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryHow many people are you registering?12345 Information shared 3 Student Information *FirstLastDate of Birth *Allergies/Medical/Behavioural Considerations Is there anything you'd like us to know to support your child in class? This may include, but is not limited to, ADHD, ASD, emotional regulation needs, behavioural challenges, allergies, or other information that helps us create a supportive experience. this information is kept confidential and used only by program staff. Student Information 2 *FirstLastDate of Birth 2 *Allergies/Medical/Behavioural Considerations 2Is there anything you'd like us to know to support your child in class? This may include, but is not limited to, ADHD, ASD, emotional regulation needs, behavioural challenges, allergies, or other information that helps us create a supportive experience. this information is kept confidential and used only by program staff. Student Information 3 *FirstLastDate of Birth 3 *Allergies/Medical/Behavioural Considerations 3Is there anything you'd like us to know to support your child in class? This may include, but is not limited to, ADHD, ASD, emotional regulation needs, behavioural challenges, allergies, or other information that helps us create a supportive experience. this information is kept confidential and used only by program staff. Student Information 4 *FirstLastDate of Birth 4 *Allergies/Medical/Behavioural Considerations 4Is there anything you'd like us to know to support your child in class? This may include, but is not limited to, ADHD, ASD, emotional regulation needs, behavioural challenges, allergies, or other information that helps us create a supportive experience. this information is kept confidential and used only by program staff. Student Information 5 *FirstLastDate of Birth 5 *Allergies/Medical/Behavioural Considerations 5Is there anything you'd like us to know to support your child in class? This may include, but is not limited to, ADHD, ASD, emotional regulation needs, behavioural challenges, allergies, or other information that helps us create a supportive experience. this information is kept confidential and used only by program staff. Emergency Contact Information *FirstLastEmergency Contact Phone *Relationship to participant(s) *Were you referred to Axé Capoeira YYC *YesNoWho referred you?Please enter the name of the person who referred you. Refer a friend who registers, and you'll receive 10% off your next tuition. Referral discounts cannot be combined with multi-student discounts. I give my permission for myself, my child/ren to appear in promotional photos or videos used by Axé Capoeira (no names will be shared without approval from guardians over the age of 18) *YesNoWaiver and Assumption of Risks *I AgreeAXÉ SOCIETY FOR CAPOEIRA PROGRAM ASSUMPTION OF RISK I am aware that in consideration of me/my child/ren participating in the activity(ies) of Axé Society for Capoeira Program, and in any activities arising in connection to or in preparation for the Axé Society for Capoeira Program, that the activity(ies) has many inherent risks, including but not limited to: General: Possible vandalism, theft, damage or loss of personal property All possible manners of harm, injury, illness, death or property damage suffered by or resulting from: Use, misuse, non-use and failure of any equipment present on the various locations/facilities used by Axé Society for Capoeira; Travel by motor vehicle, bus or any other means of transportation to, from, or during the activity(ies); Negligence on part of Axé Society for Capoeira and its members, officers, employees, students, agents, volunteers and independent contractors; Forces or nature, or other causes. Axé Society for Capoeira highly recommends that you consult with your/your child/ren’s physician prior to: 1) participating in any physical activities or 2) if I/my child/ren have/has any pre-existing medical conditions which may be affected by my/my child/ren’s participation in the activity(ies). Axé Society for Capoeira Program: Any manner of harm, injury, illness, death or property damage suffered by or resulting from: Contact with participants, volunteers, employees, animals, or other people An increased load on the heart, which may result in dizziness, shortness of breath and in extreme circumstances may result in a heart attack; Muscular injuries such as sprains, and strains, bone injuries, fainting, chest discomfort, leg cramps and nausea; Heat related injuries such as, all types of burns, heat cramps, heat exhaustion, heat stroke; Participating in activities beyond my own abilities; - The sudden malfunctioning of any equipment on the premises; - Allergic reactions to the animal(s), insect(s), pollen, plant(s), and any other allergen; - The sudden falling of structures on the premises; - Falls from structures on the premises; - My participation and use of equipment beyond my own abilities. I voluntarily consent and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage or loss, cause. Release of Liability, Waiver of claims and indemnity Agreement In consideration of my/my child/ren’s participation in the Axé Society for Capoeira Program, I understand and agree as follows: TO WAIVE ANY AND ALL CLAIMS that me/my child/ren has or may have in the future against Axé Society for Capoeira and its members, officers, employees, students, agents, volunteers and independent contractors (all of whom are hereinafter collectively referred to as “the members”); TO RELEASE THE MEMBERS from any and all liability for any loss, damage, injury or expense that I/my child/ren may suffer, or that their next of kin may suffer as a result of my participation in the Axé Society for Capoeira Program due to any cause whatsoever INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIER’S LIABILITY ACT, RSA 2000 C. 0-4 AS AMENDED ON THE PART OF THE MEMBERS; TO HOLD HARMLESS AND INDEMNIFY THE MEMBERS from any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my/my child/ren’s participation in the Axé Society for Capoeira Program; and THAT if I/my child/ren is/are supplying their own equipment, I/my child/ren will be responsible for ensuring that it is safe and well maintained and up to the requisite standards for the activity(ies) in which I my child/ren am/is/are participating in. My child/ren and I understand that the members accept no responsibility for any incidents or accidents occurring out of the use or misuse of my equipment. This agreement shall be effective and binding upon me/my child/ren’s heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or incapacity. This Waiver Shall be governed by and construed in accordance with the laws in force in the province of Alberta and the federal laws of Canada, as applicable. The courts of Alberta shall have exclusive jurisdiction over all claims, disputes and actions arising out of and related to this Event and this Waiver and the parties hereby attorn to the jurisdiction of Alberta courts. In entering into this agreement, I am not relying upon any oral or written representation or statements made by the Members, other than what is set forth in this Agreement. I CONFIRM THAT I AM 18 YEARS OF AGE OR OLDER, THAT I HAVE READ AND UNDERSTAND THIS AGREEMENT AND THAT I AM AWARE THAT BY SIGNING THIS AGREEMENT I, AND MY CHILD/REN ARE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE, WHICH MY, OR MY CHILD/REN’S HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGN MAY HAVE AGAINST THE MEMBERS. I have read and agree to the Axé Society for Capoeira policies and procedures. *Yes Policies & Procedures. Signature Clear Signature Submit