Studio 21 Dance 2021-2022 Registration
Registration for the 2021-2022 Dance Year
Dancer(s) Name *
Parent/Guardian Name *
Address *
Phone Number *
Email Address *
Auto payments - Payments will be processed between the 25th -29th of each month. To cancel autopay you must give writtennotice 30 days in advance.REMINDER: NO REFUNDS GIVEN ON TUITION. Once your account is created you will get an email invoice where you can then save your card for auto payments. *
I agree... Registration/Tuition Fees: all students must pay an annual registration fee. Tuition & Registration fees are NON-REFUNDABLE. Regardless of attendance, full tuition is due on the 25 th of each month. We do not send statementsunless tuition is past due. Service fees will incur for outstanding balances. There are no credit transfers after tuitionhas been paid. *
Photographs: Studio 21 Dance will take pictures in classes, around the studio, at special events, in rehearsalsand dance productions. These photographs could be used in brochures, websites, posters, advertisements, andother promotional materials created by the school. Photos may appear with or without names in press releases andother print advertising. *
Personal Property: I hold harmless the owners and faculty of Studio 21 Dance from the damage or loss of personproperty of items left inside the studio. Parents and students are responsible for their own belongings and makingsure they are put in designated areas and taken home at the end of their day/night at the studio. We will have a lostand found for any items left around the studio. *
Accident or Injury: I release Studio 21 Dance and its staff from any responsibility for any accident or injuryincurred during classes, rehearsals, or performances. I further authorize any representative of Studio 21 Dance toobtain any medical treatment that may be deemed necessary. *
Withdrawing a Student: Should it become necessary to discontinue classes for any reason, a withdrawal formmust be signed and submitted to Studio 21 Dance by the 15 th day of the prior month that you child(ren) will no longerbe taking classes. Otherwise, tuition charges will continue to incur, regardless of attendance. *
For ages 11+/Medication: Do we have permission to dispense medication to your student, per the manufacturer dosage recommendation? We are sometimes approached bystudents requesting medications for headache, or other minor ailments *
Does your dancer have any medical conditions we should be aware of? *
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event.I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:I HEREBY WAIVE, RELEASE, AND DISCHARGE Studio 21 Dance Academy and all divisions thereof of any and all liability and responsibility for injuries, sickness, pandemics, accidents, natural disasters and/or acts of God incurred during participation in and/or instruction of camps, intensives, private instruction, choreography or any activity I may participate.I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of anykind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Studio 21 Dance Academy) and/or their directors, officers, managers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this waiver, release and registration form from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise.The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. - please type full legal name *
The undersigned parent and/or natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. - Type full legal name *
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