I authorize Chickee's Dance World to charge monthly tuition to my credit card provided herein on the first Monday of each month. I authorize Chickee's Dance World to charge miscellaneous fees (ie costumes, competitions, conventions, etc.) to my credit card provided on the date they are due. I agree that I will pay for these purchases in accordance with the issuing bank cardholder agreement. I understand that this authorization will remain in effect until I cancel the agreement in writing with the Chickee's Dance World. I understand that should I cancel the agreement after the first class of the month that I am responsible for that month of tuition. In addition, I agree to notify Chickee's Dance World of any changes to my payment information at least 10 days prior to the next payment authorization period (billing date). I am the authorized user of this payment card and will not dispute the scheduled payments outlined above.

I understand that:

Payments for Competition Team Evaluations is due upon registration.This fee is not REFUNDABLE for ANY REASON.

I give my permission to Chickee's Dance World and its owners and operators to seek medical treatment for the students listed above in the event they are not able to reach a parent or guardian. In the fields above, I have declared any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health.

I give Chickee's Dance World my permission to use photos and videos of the dancer(s) above for possible advertisement purposed in brochures, newspaper ads, social media and the studio website. *IF A CHILD LEGALLY CANNOT HAVE THEIR PICTURE TAKEN PLEASE CHECK FIELD, CONTACT CDW AND WRITE NO PHOTOS IN THE NOTE SECTION*

I have enrolled myself/my child in the dance program offered by Chickee's Dance World. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various dance activities. I hereby affirm that myself/my child is in good physical condition and does not suffer from any known disability which would prevent or limit the participation in this dance program. In consideration of my/my child's participation in this program I, hereby release Chickee's Dance World and its agents from any claims, demands and causes of action as a result of my voluntary participation and enrollment. I fully understand that I/ my child may injure myself/his or herself as a result of enrollment and subsequent participation in this program and I, hereby release Chickee's Dance World and its agents from any liability now or in the future for conditions that may be obtained. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot or any other illness or soreness that I/ he or she may incur, including death.

As the legal parent or guardian, I release and hold harmless Chickee's Dance World its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any injury, loss or damage that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Chickee's Dance World, its owners and operators or in route to or from any of said premises. Covid-19 Release Waiver: I hereby acknowledge the contagious nature of COVID-19 and other contagious diseases and viruses and voluntarily assume the risk that I and/or my children may be exposed to or infected by COVID-19 by attending and participating and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 and other contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, independent contractors, volunteers, and program participants and their families. I release Chickee's Dance World, its instructors, independent contractors and all associates from liability for harm, injury or death pertaining to COVID-19 and other contagious diseases and viruses.