You must have Flash installed to view this feature.

Academy Registration Form

Please note:

  • To register for any course please fill out this form.
  • 1 form per student.
  • No taxes applied to students 14 years old and under.
  • Registration and full payment must be received no later than one week prior to the beginning of any classes.
  • This is a non-transactional Registration Form. A Segal representative will contact you as soon as possible to process your payment. You may also call 514-739-7944 to complete your registration. 
  • You may be eligible for our Scholarships.
* Required fields

Applicant Information

* First Name
* Last Name
* Address
* City
* Postal Code  
* Home Phone () -
Applicant's Cell () -
* Applicant's Email
Date of birth
School
Grade
Emergency Contact Name
(parent/guardian)
Home Phone () -


Are there any allergies, physical, learning needs or other concerns we many need to know about to ensure your best experience?
      If yes, please explain


Parent Information

For students under 18

First Name
Last Name
Parent's Home Phone () -
Parent's Cell Phone () -
Parent's Email


* PLEASE INDICATE YOUR COURSE(S) SELECTION

$
Select an alternative (Only required if you are registering for only one course)

$

Subtotal  $



Do you have any experience in the course(s) you will be taking?
      If yes, please briefly describe
Are you interested in receiving updates by email about future programs and events at the Academy?
     
How did you hear about the Academy?
Search Engine
Ad in the Gazette
Through the Leanor and Alvin Segal Theatre
A Friend
Saw the Academy Brochure
Other (please specify)
     


GRAND TOTAL  $


Please read the following to find out about our policies

COURSE CANCELLATION POLICY

  • Cancellation in writing one week prior to the first class – Full Refund.
  • Cancellation in writing before second class – 10% of fees withheld.
  • Cancellation in writing after second class – 20% of fees withheld.
  • Cancellation after third class – No Refund.

If a student must cancel due to medical reasons a physician’s note must be provided and a pro-rated refund or credit of equal value towards a future course at the Academy will be applied.

TERMS AND CONDITIONS

All courses have a minimum and maximum enrollment – should a course not meet enrollment, cancellation may be necessary. The Academy reserves the right to change instructors without prior notice. The Academy has a zero tolerance policy for inappropriate conduct. Any student showing a lack of respect for Segal Centre staff and property, as well as fellow students or instructors, will be dismissed from the class permanently with no refund of fees. Participants are expected to be on time. The Academy cannot assume responsibility for students before or after class time. The Academy reserves the right to videotape or photograph classes, screenings and performances to publicize the program. The Academy is not responsible for lost or stolen property.

 * I agree to the terms and conditions

Please review your contact information and registration selection before submitting this form.




Segal Centre - 5170 Côte-Ste-Catherine, Montréal, Quebec, Canada H3W 1M7 Tel. (514) 739-2301 Fax (514) 739-9340
© 2009 Segal Centre for Performing Arts