2017  General  Payment  Agreement  Form   The  Payment  Plan  prorates  costs  over  ‘up  to’  4  installments  to  be  paid  in  full  prior  to  the  start  of  class.    Any  special   circumstances  requiring  additional  installments  and/or  time  will  be  considered  with  written  request.    In  this  way,   students  and  families  avoid  having  to  make  large  payments  at  the  beginning  of  each  semester.    There  are  no  finance   charges  or  interest  rates  associated  with  this  plan.    Fill  out  and  return  the  form  with  the  initial  deposit  in  order  to  secure your  spot  in  the  class(es).    Contact  Anita  at  781-934-7555  or  anita@dbms.org

Account  Holder  Information:   

First  Name:_________________________  Last Name:___________________________  Email:______________________________    Cell  Phone:_________________________

Mailing  Address:_________________________________  City:____________________  State:______  Zip:_______    

Participant  1:   

First  Name:_________________________  Last Name:___________________________  

Birth  Year:  _______    

Program:  ___________________________________  Session:  _____  Date(s): _______  

Group:  _____  Time:  _____

Program:  ___________________________________  Session:  _____  Date(s):  _______  

Group:  _____  Time:  _____    

Participant  2:   

First  Name:_________________________  Last Name:___________________________  

Birth  Year:  ________  

Program:  ___________________________________  Session:  _____  Date(s):  _______  

Group:  _____  Time:  _____

Program:  ___________________________________  Session:  _____  Date(s):  _______  

Group:  _____  Time:  _____    

Emergency  Contact:    

Name:_________________________  Phone Number:___________________________  

Please  explain  the  circumstances  that  make  the  Payment  Plan  a  necessity  for  your  family.

 ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Total  Due:  $_____________  by  date  (of  first  program):__________

Payment  1:__________  Date  1st  of  Mo:____________  

Payment  2:__________  Date  1st  of  Mo:____________

Payment  3:__________  Date  1st  of  Mo:____________  

Payment  4:__________  Date  1st  of  Mo:____________

By  signing,  I  confirm  that  I  have  read  and  agree  to  the  attached  Terms  and  Conditions.

  Signature:________________________________        Date:  _______/______/_______


Terms and Conditions

Terms of Agreement: I agree to pay the installment(s) in time at the risk I may forfeit the spot in the class.

Policies, Terms and Conditions The Duxbury Bay Maritime School admits students of any race, color, and national or ethnic origin. A drug and chemical free environment will be strictly maintained.

Student Supervision & Swimming Ability DBMS is not equipped to supervise students before or after class times. Children are to be dropped off and picked up on time. All students are assigned to an instructor who keeps a daily log and progress report of each child. The student’s daily, as well as overall progress, will also be monitored by the Program Director and senior staff. Any questions regarding a student’s progress should be directed to the instructor or Program Director. Many of DBMS’ course descriptions include a requirement that the participant to be a “Competent Swimmer“. DBMS defines a “Competent Swimmer” as someone who is able to readily jump into deep water and swim 25 yards unassisted. I hereby attest that I/my dependent’s swimming ability meets or exceeds the level required in DBMS’ course description. I agree I/my dependent will properly wear a U.S. Coast Guard approved life vest at all times while participating in DBMS on-the-water programs. Except for Jr Rowing classes, DBMS does not require participants to take a formal swim test.

Weather Policy All classes meet rain or shine. Only DBMS staff may cancel or reschedule Private and Semi-Private lessons due to poor weather conditions. In some instances, this may be done with very short notice or after the lesson has already started. After the decision is made, the participant will be notified as soon as possible and DBMS will attempt to reschedule the lesson if there is availability. If not, a full credit or refund for the amount of the lesson will be given in the original form of payment.

Booking Cancellation / Refund Policy

Bookings may be cancelled at any time on our website by logging in to your DBMS Customer Account, or by contacting the registrar. Registration is forfeited after the start of the class. The following cancellation fees apply:

• Classes Cancelled >=30 days before class starts: $25 per student per class

• Classes Cancelled <30days before class starts: $25 or 25% of the class fee, whichever is greater, per student per class

• Private & Semi-Private lessons cancelled <48 hours before class starts: 100% of lesson fee If the customer account holder/participant has a balance due, the refund amount is first applied to the balance due and the remaining amount is refunded. Payment Policy To secure a seat in a class and be placed on the roster, all classes must be paid IN FULL at the time of registration. Class participation is not allowed unless you are on the roster.

Payment Policy To secure a seat in a class and be placed on the roster, all classes must be paid IN FULL at the time of registration. Class participation is not allowed unless you are on the roster.

Statement of Medical Condition & Consent for Medical Treatment I attest to the fact that I am/my dependent is in good health and that there is no medical condition that precludes my/my dependent’s involvement in any of the programs of the Duxbury Bay Maritime School (DBMS). I grant permission to DBMS and its employees to administer medical treatment that may be deemed necessary in event of injury or illness.

Conduct Policy The goal of DBMS programs is to develop students’ individual strengths, to improve their skills, and to have fun while doing so. Programs require a high standard of commitment, effort, and personal conduct. Decent, self-respecting behavior and true sportsmanship are expected of everyone (students as well as parents) while participating in the school’s program, while on the school’s property, and while representing DBMS off campus. Failure to adhere to code of conduct could result in disciplinary action, including suspension or expulsion without refund of program fees.

Scholarships Financial Aid is limited to One Class per Year per Student and Limited to Youth through age 18. Anyone seeking information about financial assistance should contact Beth at the DBMS office 781-934-7555 x108. Please send in your completed scholarship applications (along with copies of W2s) to beth@dbms.org. Applications must be submitted at least two weeks prior to program start date.

Consent, Waiver & Indemnity Agreement By signing up for this course, I accept that: – I, or someone I have made arrangements with, is responsible for getting my student or myself to and from DBMS. – There are risks inherent in sailing, sailboat racing, rowing, kayaking and other water-based and land-based programs and that accidents can occur on the water as well as on land during any DBMS program. Such accidents can result in serious injury and death. – I have freely waived all claims against and release and discharge DBMS and its officers, directors, agents, employees and volunteers from any and all liability, loss, damage, and expense which may result from participation in DBMS programs. – All students must properly wear a U.S. Coast Guard approved life vest at all times while participating in DBMS on-the-water programs. – I am aware that I will be charged $5 if I make a booking at the school’s office or over the phone, rather than online. – DBMS reserves the right to photograph participants for publicity purposes.