Student Information and Registration form Please fill out the following form Registration Form First Name * Last Name * Mailing Address * Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\’IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountry Student Telephone Phone * Student Email * Emergency Contact Name * Emergency Contact Phone Number * Birthdate * Gender * MaleFemalePrefer not to say Do you have Provincial or Territorial Medical Insurance? * YesNo Insurance Number * FOR INTERNATIONAL TRAVELLERS – Do you have Travel Insurance? * YesNo Insurer * Do you have a long-term physical or mental health condition that limits the kind of activity that you can perform on a daily basis? yesno Please state if you have any allergies How did you hear about us? NewspaperFriendFacebookInstagramOnline advertisementBrochureOther Program/Workshop *Please select the Program or Workshop you wish to register for.Theatrical Transformations WorkshopRocky Mountain Winter Adventures ProgramRocky Mountain Outdoor Adventures ProgramCross Country Skiing and Interpretive Nature TourIntroduction to Snow Shoeing and Nature TourCariboo Snowcat Skiing and SightseeingMountain Bike Basic Riding Skills and RepairIntroduction to Backcountry CampingIntroduction to Flatwater CanoeingSpringtime In The Rockies WorkshopBack To The Land Basics Terms and Conditions * By checking yes, you state that you agree to the Terms and Conditions of the Valemount College. REFUND POLICY 1. If the institution receives tuition from the student, or a person on behalf of the student, the institution will refund the student, or the person who paid on behalf of the student, the tuition that was paid in relation to the program in which the student is enrolled if: (a) the institution receives a notice of withdrawal from the student no later than seven days after the effective contract date and before the contract start date; (b) the student, or the student’s parent or legal guardian, signs the student enrolment contract seven days or less before the contract start date and the institution receives a notice of withdrawal from the student between the date the student, or the student’s parent or legal guardian, signed the student enrolment contract and the contract start date; or 2. The institution will refund the tuition for the program and all related fees paid by the student or a person on behalf of the student enrolled in the program if the student is enrolled in the program without having met the admission requirements and did not misrepresent his or her knowledge or skills when applying for admission. 3. Full payment is required at time of booking to hold your space as student numbers are limited. OTHER POLICIES/NOTES: This program does not require approval under the Private Training Act and therefore students may not file a claim against the Student Tuition Protection Fund with the trustee in respect of the program.Yes, I agree to the terms and conditions Verification Please enter the following digits *Digits: 71 This box is for spam protection – please leave it blank: Select your Program/Workshop Theatrical Transformations Workshop $499.00 CAD