Dear Tree Student Application & Membership Agreement
Dear Tree Learning Center & Art Studio
Sign in to Google to save your progress. Learn more
Email *
Name  *
First and last name
Phone number *
Address *
Emergency Contact
First and last name
Emergency Contact Phone number
Child Name
First and last name
Date of Birth
Student Information
Has your child ever been suspended or dismissed from school?
Does your child have any physical, emotional, and or academic disability?
Does your child have any allergies and or medical conditions?
Are your child's immunizations requirements and negative PPD skin up to date?
Please explain use space below to clarify any answers from above:
Program Registration & Interest (Check all that apply) *
Photographs are taken regularly around the facility. Some images often feature students in our internal & external communications to Dear Tree members and followers. However, if you do not wish to have your child’s photo used in outside communications please indicate:
Membership Agreement
This Membership Agreement (“Agreement”) is between Hopscotch Corp (doing business as “Dear Tree Guam”) (the “Dear Tree Learning Center” or “Seller”) and the undersigned applicant (“Member” or “Member”). This Agreement includes and incorporates by reference (i) the provisions on the face of this Agreement, (ii) the attached Membership Agreement Terms and Conditions, (iii) the attached Guidelines of the Dear Tree as now in effect and as amended by the Dear Tree from time to time, and (iv) such rules and regulations as may be posted at the Dear Tree from time to time.
Membership Type
Clear selection
This Agreement requires a minimum term of paid months, from the Start Date to the End Date. After the End Date, your membership will continue, and you will be charged on a month-by-month basis at then applicable dues rates until you cancel in accordance with Section 3(a) of this Agreement. You understand that this Agreement cannot be canceled before the End Date written on the left column, except as specifically provided for in this Agreement. (Please Initial)
Signature (Type) *
By typing your name below, you agree that you have read, understood, and received a complete copy of this Agreement. You agree to be bound by the Membership Agreement Terms and conditions, the Guidelines of the Dear Tree, and such rules and regulations as may be posted at the Dear Tree from time to time, all of which are incorporated by reference in this Agreement. This Agreement will become effective when signed by you and accepted by the Dear Tree. (Please type your full name)
Today's Date *
Membership Agreement Terms & Conditions
1.MEMBERSHIP: Your membership is a contractual privilege to use the Dear Tree facilities, equipment, and services, and participate in Dear Tree sponsored activities, programs and events (collectively the “Dear Tree Facilities”) offered from time to time by the Dear Tree to your type of membership during the Dear Tree’s published hours of operation. The Dear Tree reserves the absolute right without notice to add, change or eliminate any Dear Tree Facilities or membership types and to change its hours of operation. Your membership does not entitle you to any interest or ownership in the Dear Tree or its property and confers no right to participate in the management or operation of the Dear Tree. The membership types, the amount of initiation fees, dues, and other charges payable by the members, the suspension and termination of members, and all other matters affecting or relating to your membership shall be in the Dear Tree’s sole discretion.
2. PAYMENTS: (a) Membership Payments. You agree to pay the initiation fee and monthly dues rate set forth on the front of this Agreement. Monthly dues and house charges shall be debited from your account through the electronic funds transfer system on a monthly basis and reflect the current month’s dues and the prior month’s charges. Except as stated in this Agreement, all membership fees, dues, and other payments are non-refundable. You shall not be relieved of your obligations to make any such payments and no deduction or refund of dues shall be made for your failure to attend or use the Dear Tree Facilities due to vacation, travel, or other personal commitments. (b) Adjustment to Dues Rates and Other Fees. Monthly dues rates, charges and fees for services are subject to change, as deemed necessary by the Dear Tree. The Dear Tree may increase monthly dues rates by providing you with a minimum of thirty (30) days written notice. If you have a twelve (12) month paid commitment, the Dear Tree will not change the monthly dues rate during such initial twelve (12) month period. (c) Service Charges and Late Fees. If any payment to the Dear Tree, including by check, charge or bank draft, is not honored, or if your account is past due, the Dear Tree shall have the right to the following remedies, in addition to any other legal or equitable rights: (1) assess a service charge of $30.00 for each dishonored transaction and require reimbursement for cost collection; (2) assess a late fee of $20.00 for all past due accounts; (3) collect the current and past due balance in any subsequent months; and/or (4) suspend or terminate this Agreement. The Dear Tree reserves the right to change these service fees and late fees at any time. All payment disputes must be submitted in writing to the Dear Tree within 120 days of the disputed charge, to the extent permitted by law. The Dear Tree may transfer this Agreement to a collection’s agency, and you will be obligated to pay any collection and/or legal costs incurred by the Dear Tree in enforcing this Agreement.
3. CANCELLATION: (a) Additional Rights to Cancellation. After the initial (3) three-day cancellation period set forth on the front of this Agreement, you or your estate may also cancel this Agreement for any of the following reasons: (1) if upon a doctor’s order, you cannot physically receive the services because of significant physical disability for a period in excess of three (3) months; (2) if you die, in which case your estate shall be relieved of any further obligation for payment under this Agreement not then due and owing; (3) if you move your residence more than five (5) miles from any health Dear Tree operated by the Dear Tree (you must provide proof of new residence); or (4) if the services of the Dear Tree cease to be offered as stated in this Agreement. Written notice of cancellation setting forth the reason for cancellation under this section shall be delivered in person or sent by certified or registered United States mail to the Dear Tree at the address in this Agreement. If your cancellation is due to a physical disability, written verification from a licensed physician must accompany your notice of cancellation. All monies, excluding the initiation fee, paid pursuant to this Agreement canceled for any of the above reasons shall be refunded within fifteen (15) days of receipt of such notice of cancellation; provided that, the Dear Tree may (A) retain the expenses incurred and the portion of the total price representing the services used or completed, and (B) demand the reasonable cost of goods and services which you have consumed or wish to retain after the cancellation of this Agreement. In no instance shall the Dear Tree
demand more than the full contract price from you. If you have executed any credit or loan agreement to pay for all or part of the health Dear Tree services, any such negotiable instrument by you shall also be returned within fifteen (15) days. Any reinstatement of a membership that is terminated expired or canceled will require payment of a $50.00 reinstatement fee.
(b) Cancellation by Member. You may cancel your membership at any time after the paid commitment period indicated on the front of this Agreement, by giving the Dear Tree thirty (30) days advance written notice. Such cancellation shall be deemed effective on the first day of the calendar month following the expiration of the 30-day notice period and all outstanding dues and charges have been paid to the Dear Tree. You will remain liable for payment of dues and other charges for periods prior to the effective date of cancellation. If you prepaid your membership dues or other charges and are eligible to cancel your membership before the end of the prepaid period, Dear Tree will refund prepaid amounts only for unused membership time. Any amounts due by you will be deducted from any refund due to you. If you cancel during your paid commitment period, you will remain responsible for paying dues for the remaining commitment period. Until you provide written notice of cancellation as stated above and make all outstanding payments, you will continue to be charged monthly dues. (c) Cancellation by the Dear Tree. The Dear Tree may suspend or cancel your membership at any time for (1) failure to pay your monthly dues and other charges when due; (2) any other breach of this Agreement; or (3) any violation of the Guidelines or other rules and regulations of the Dear Tree. The Dear Tree also has the right to cancel your membership at any time without cause. You will remain liable for payment of dues and other charges for periods prior to the effective date of cancellation. No refunds shall be made for membership dues and other charges except as specifically provided for in this Agreement. If your membership is terminated for cause, the Dear Tree reserves the right to retain the unused portion of any prepaid amounts made by you.
4. GUIDELINES, RULES, AND REGULATIONS: You agree to abide by the attached Dear Tree Guidelines, and all rules and regulations of the Dear Tree, as the same may be amended from time to time at the Dear Tree’s sole discretion. Any member who, in the sole determination of the Dear Tree, violates the Dear Tree’s Guidelines, rules, or regulations, or is loud, offensive, uses profanity, harasses, is bothersome to other members, residents, guests or employees, or otherwise behaves in an inappropriate or unbecoming manner, may be suspended or terminated by the Dear Tree.
5. MEMBER’S HEALTH WARRANTY: You represent that you are in good health and have no disability, impairment, injury, disease or ailment, preventing you from engaging in exercise or which could cause an increased risk of injury or adverse health consequences as a result of exercise. You assume full responsibility for your use of the Dear Tree Facility and shall indemnify the Dear Tree, its affiliates, agents and employees, against any and all liability arising out of your use of the Dear Tree Facilities. A physical exam by your physician is recommended before commencing any exercise program and especially if you are elderly, pregnant, or unaccustomed to physical exertion.
6. ACKNOWLEDGEMENT OF RISK: You, on behalf of yourself, and any dependent(s) and guests, represent that, you understand that engaging in in-person classroom activities and the use of the Dear Tree Facilities include an inherent risk of minor or major life-threatening injury to persons and property and death. You understand that risk of injury to persons and property includes, but is not limited to, injuries arising from or relating to (a) the use by you, your dependent(s), guests or others of exercise equipment, locker rooms, wet areas and other Dear Tree Facilities; (b) participation by you, your dependent(s), guests or others in any supervised and unsupervised activities, programs, classes, events on or off the Dear Tree premises, including any the Dear Tree sponsored activities and events; (c) any personal training, instruction, supervision or dietary recommendations by the Dear Tree or its staff; (d) medical disorders that may occur from use of the Dear Tree Facilities such as heart attack, stroke, death, heat stress, sprains, strains, broken bones, and torn muscles, tendons and ligaments among others; (e) accidents that may occur anywhere in or around the Dear Tree (including common areas, fitness areas, locker rooms, steam rooms, pool areas, saunas, etc.) or while participating in activities or events sponsored by the Dear Tree or while traveling to or from the Dear Tree; and (f) theft or loss of property while using the Dear Tree Facilities. Accidental injuries include those caused by you or by other persons
and those, for example, of a slip and fall nature. You, your dependent(s), and guests agree to use due care when using any of the Dear Tree Facilities and/or when participating in any Dear Tree sponsored outside activities and events.
7. DAMAGE TO PROPERTY: You understand and agree that the Dear Tree is not liable for loss, damage or theft of your personal property or that of your guests while in or on the Dear Tree Facilities. You shall be responsible for any and all damage to any Dear Tree property caused by you, your guests, or your dependent children.
8. INDEPENDENT CONTRACTORS: From time to time the Dear Tree will make available to you and your guests the services of independent contractors. The Dear Tree does not warrant or guarantee the quality of these services and does not guarantee that these services will remain available to you or your guests for any period of time, and hereby disclaims all liability arising out of such services.
9. SEVERABILITY: If any provision or any part of any provision of this Agreement is held unenforceable, such provision or portion there of shall be severed from this Agreement, and such unenforceability shall not affect the other provisions of this Agreement.
10. NOTICES: Please remember to inform the Dear Tree accounting office of any address or payment changes. Any notice given under this Agreement shall be considered delivered when mailed to your address listed on the front of this Agreement or as later changed by written notice to the Dear Tree. Any notice you send to the Dear Tree shall be considered delivered only when received by the Dear Tree.
11. ASSIGNMENT: The Dear Tree may assign this Agreement at its sole discretion. You may not assign this Agreement. This Agreement shall be binding upon and inure to the benefit of the parties’ respective successors and assigns.
12. COUNTERPARTS: This Agreement may be signed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. Counterparts may be exchanged by fax or electronic means (e.g., PDF), all of which shall be binding.
13. ENTIRE AGREEMENT: This Agreement contains the entire agreement of the parties with respect to the subject matter hereof and supersedes any discussions, offers, proposals, agreements or promises with respect thereto. This Agreement may be modified only by a written amendment signed by you and the General Manager. Employees are not authorized to make any independent agreement.
14. GOVERNING LAW: This Agreement shall be governed by and construed in accordance with the laws of the Territory of Guam. All actions arising under this Agreement shall be exclusively brought in accordance with LAWS of the Territory of Guam.
15. ATTORNEYS’ FEES: If any action, suit, or other proceeding is brought relating to the enforcement or interpretation of this Agreement, the prevailing party shall recover all of such party’s reasonable fees and expenses, including attorneys’ fees and expenses incurred in connection with such action. This section shall not be deemed to provide for the award of attorneys’ fees for personal injury, or non-contractual claim.
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy