I understand by signing this form it is in effect as long as my child participates in any activity at DancElation. I understand that it is my job to review this contract and the policy and procedure packet each year. It is available to me on the blog www.dancelation.blogspot.com or in the studio.
Date:_______________ Child’s Name:______________________________ Age:________
Grade:_________ Sex: M F Birthdate:________________________ Mother’s Name:_______________________Home#:_____________Cell #:_________________ Work#______________________
Father’s Name:_____________________Home#:__________________Cell#:____________________ Work#:______________________
Address:______________________________City:________________Zip:__________________
E-Mail Address:_____________________________________(most correspondence will be done via email). (We Must Have this!!!!!!!)
Person to contact in case of emergency (other than parent/guardian):
1 st Name:________________________________ Phone #:_____________________
2 nd Name:________________________________ Phone #:_____________________ Medical conditions or issues of special attention: Note: We do not assume any responsibility for the care or supervision of your child’s medical conditions. Please write the day and time of the class(es) you are signing up for. Schedule and cost are posted at the studio or blog www.dancelation.blogspot.com.
Class(es):Day/Time___________________________________________________________________Registration Fee: $30 per child
Tuition:________________
Number of classes enrolled in:__________ Total monthly tuition:_________________
Size:_____ Leo:___________Shorts:____________ Tights:____________Shoes:_______ jazz_________ ballet___________
Additional Child
Date:_______________ Child’s Name:______________________________ Age:________
Grade:_________ Sex: M F Birthdate:________________________ Class(es):Day/Time___________________________________________________________________Registration Fee: $30 per child
Tuition:______________-$5
Number of classes enrolled in:__________ Total monthly tuition:_________________
Size:_____ shirt:___________Shorts:____________ Tights:____________Shoes:_______
Jazz:_________ Ballet:_________
Additional Child
Date:_______________ Child’s Name:______________________________ Age:________
Grade:_________ Sex: M F Birthdate:________________________ Class(es):Day/Time___________________________________________________________________Registration Fee: $30 per child
Tuition:______________-$5
Number of classes enrolled in:__________ Total monthly tuition:_________________
Size:_____ shirt:___________Shorts:____________ Tights:____________Shoes:_______
Jazz:_________ Ballet:_________
Please read the back of this form. Print your name, sign and date the bottom and return it to the studio. Parent Financial Agreement PAYMENTS: I understand that tuition is due the first week of each month. Any tuition paid after the last day of the month will receive a $10 late fee for dance. This fee will not be waived and must accompany payments made after the last day of the month. I agree to pay all tuition, the annual registration fee of $30, and any applicable costuming fees. I understand that my child will not be allowed to participate or perform unless all fees are kept current. All payments must be placed in the payment box in studio. • Payments by check-Please make your check payable to Celeste McKinney. Print your child’s name in the memo section of your check to ensure your amount is properly credited. • If mailing, please mail to 1931 S River Run Drive, Huntsville, UT 84317 • I agree to pay interest at the rate of 18% annually on all past due balances from the original due dates, plus court costs and reasonable attorney’s fees, with or with out suit, incurred in collecting any past due balance, and a collection fee of up to 40% if my account is assigned to a collection agency. • DancElation requires a 30 day written withdrawal notice. If you choose to withdraw your child, you will be charged for 30 days of tuition, effective the first day your written notice is received in studio. This does NOT apply to competition teams. They are responsible for all fees, tuition, and costumes for the entire year if they drop from the team for any reason or if they are suspended from the team. • I understand that at times the facility takes pictures of classes, competitions, & recitals, and that these pictures may be used on the websites or advertisement. By signing below I give my permission for my child’s photos to be used. I understand that at no time are full names revealed on the website or Ad, and no compensation will be given if my child’s photos are used. I will not hold DancElation responsible for injuries sustained as a result of participating in any class at the studio, rehearsals, recitals, or competitions. I understand that they strive to provide a safe and fun atmosphere, however, accidents may happen. They will notify parents of any injury they become aware of during class, and will phone you immediately if it seems serious. Please read the Release & Waiver of Liability and Indemnity Agreement Form on the next page fully and completely before signing. _____ My signature below states that I have read and agreed to DancElation Policies and Procedures. Furthermore, it states my acceptance to the terms and conditions herein implied. I accept full responsibility and liability for my child. ______ I________________________________________/____________________________/_____________ Parent/Guardian Name (print) Signature Date
DancElation. Release and Waiver of Liability and Indemnity Agreement (Read Carefully Before Signing) In consideration of being permitted to participate in any way in the Dance/Tumbling indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parents(s) and/or legal guardian(s) of the minor participant named below agree: 1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below Dance/Tumbling activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agreed that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. 2. I/WE fully understand and acknowledge that: (a) There are risks and dangers associated with participation in Dance/Tumbling events and activities which could result in bodily injury, partial and/or total disability, paralysis and death. (b) The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe. (c) These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but no limited to, the Releasees named below. (d) There may be other risks not known to us or are not reasonably foreseeable at this time. 3. I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below. 4. I/WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE DancElation, Eden Holding & Development-Paul Judd, facility used by the participant, including its owners, directors, teachers, coaches, managers, promoters, lessees of premises used to conduct the Dance/Tumbling event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding the Dance/Tumbling facility or events held at such facility and each of them, their directors, teachers, officers, agents, employees, all for the purpose herein referred to as “Releasee”… FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal representatives, assigns, executors, heirs and next to kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT OR DAMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE. 5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledge that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES. 6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. 7. On behalf of the participant and individually, the undersigned partner(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite this release, the participant makes a claim against any of the Releasees, the parent(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
DancElation
Date____________________
Parent or Guardian Signature _____________________________________________________
Parent or Guardian Signature _____________________________________________________ Printed Name of Participant________________________________________________________ Address of Participant_________________________________________________________________
Received By____________________________________________________________________
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