USE THIS FORM IF YOU WANT TO MAIL IN YOUR REGISTRATION.
OTHERWISE, ONLINE REGISTRATION IS QUICK AND CONVENIENT
REGISTRATION FORM
2014-2015 Dance Season
Student name______________________ AGE _____Birthdate________
Note: Each additional student/child needs separate registration form
Parent’s name _____________________________________
Street Address_____________________________________
City ______________________
Zip _______________
Home phone: ___________ ____
cell phone: _________
E-mail: __________________________________________
Please circle the best way to contact you: email or phone
Are there any special medical or health conditions we should know about?
(please provide details on back of this form)
Student name:
Class
Day
Time
Teacher
#hours
(please use back of this form for additional classes)
Total hours = ____________
Monthly tuition* =_______
please include the $35 annual registration fee ($50 for family)
By signing below, I understand that EDS does not provide monthly statements/bills for tuition due. In addition, I agree to pay EDS
for services rendered per the above monthly tuition total at the beginning of each month and no later than the 10 th of the month. I
need to notify EDS,in writing, BEFORE the first of the month, or I will be charged tuition for that month. Please see the attached
EDS policies for full details on tuition, makeup classes or late payments. I also give my minor child permission to participate in
classes and performances offered by EDS & release EDS and their employees from all liability per the attached waiver outlined in
the master EDS “Waiver and Release of Liability” policy.
No student may start classes without a signed registration form, initialed contract and a signed Release of Liability form.
Parent’s Signature: _________________________ date:___________
Please send this form with your 1st month’s tuition and registration fee to:
1665 Cheryl Way Aptos 95003
**Elaines’ Dance Studio Contract & Policies 2014-2015**
______(initial)
Holidays
Holidays generally follow the local school schedules. Holiday dates are posted on the
website www.elainesdance.com and notes will be given to your child prior to each holiday
period. If you have specific questions about holiday schedule, please email me.
______(initial)
Attendance and Tardiness
Attendance is taken at each class. Good attendance is imperative, as absences and
tardiness can hold back the entire class. Please make every effort to have your child
attend and be on time to every class.
______(initial)
Insurance / Waiver
Elaine's Dance Studio (EDS) does not carry medical insurance for its students. It is
required that all dance students be covered by their own family insurance policy. If injury
or illness does occur, it is understood that the student's own policy is the only source for
reimbursement. Please see separate waiver and release of liability form on next page.
______(initial)
Use of Photography
It is understood the Elaine’s Dance Studio (EDS) reserves the right to use any
photography and videotaping of a student’s performance or classes for purposes of
advertising, promoting or publicizing the studio. All ownership, including copyright, shall
belong to Elaine’s Dance Studio.
______(initial)
Studio Attire
Students will not be allowed to dance without the proper shoes and attire.
Preschool/Kids Combo classes: Pink ballet shoes, tap shoes, any style leotard and tights.
Ballet (no exceptions): Black leotard, pink tights, pink ballet shoes, hair secured back in a
bun - no wispies please.
Hip Hop: Dance or workout clothes; “clean” tennis shoes a must!
Jazz: Jazz pants, bike shorts, leotards, tank tops, Jazz shoes.
______(initial)
Fees For Services Rendered
a. Tuition is due with the first lesson of each month. Monthly tuition rates remain the
same, whether it is a Long (5 class) or short (3 class) month. This includes the June recital
month. There will be no monthly statements sent out, unless you are overdue. There is no
discount for classes missed or absences.
b. I agree to pay Elaine’s Dance Studio (EDS) for services rendered (e.g. the teaching of
dance lessons) according to the charges outlined in the EDS tuition schedule and this
registration form.
c. A $35.00 annual registration fee ($50 for family) is due at the time of registration.
There is also a $7.00 late fee for tuition received after the 10 th of the month. Should the
Client fail to pay EDS the full amount specified in any invoice within 30 calendar days of
the invoice's date, the Client may be referred to a Collection Agency.
Initialing each of the above signifies that you have read, understood & agree to comply with each policy
2014-2015
WAIVER AND RELEASE OF LIABILITY, CONSENT TO EMERGENCY MEDICAL
TREATMENT & STUDIO POLICY AGREEMENT
Assumption of Risk
I, the undersigned parent or guardian of the below named minor child (the
“Participant”), who desires to participate in dance classes and performances
offered and organized by Elaine’s Dance Studio (the “Studio”), hereby acknowledge
that I am aware that there are significant risks associated with participation in
such dance classes and performances, including, without limitation, the risk of
serious bodily injury or death. On behalf of myself, my spouse and Participant,
and our respective heirs, administrators, representatives and successors, I
willingly assume such risks. Further, I hereby represent that Participant has no
physical or mental disability or impairment or any illness that will endanger
Participant or others in connection with Participant’s participation in the dance
classes and performances offered by the Studio.
Waiver and Release
I, the undersigned parent or guardian of the Participant, for myself, my spouse and
Participant and our respective heirs, administrators, representatives and
successors, hereby waive the right to bring any claim or suit and hereby
voluntarily release and discharge the Studio, its owner (Elaine McCarthy),
employees, independent contractors, agents and insurers from any and all claims,
demands, causes of action, liabilities, damages, costs or expenses (referred to
herein collectively as “Claims or Losses”) arising out of, relating to or in any
way connected with Participant’s participation in the Studio’s dance classes and
performances, including, without limitation, any Claims or Losses for personal
injury, wrongful death or property damage allegedly arising out of the negligent
acts or omissions of the Studio’s owner(s), employees, independent contractors or
other agents.
Consent to Emergency Medical and Dental Treatment
I, the undersigned parent or guardian of the Participant, hereby authorize the
Studio and its owners, employees, independent contractors and other agents to
consent to and authorize the emergency medical treatment of the below named
Participant by a physician duly licensed under the provisions of the California
Medical Practice Act or by a dentist duly licensed under the California Dental
Practice Act. I understand that this Consent to Emergency Medical and Dental
Treatment will be used by the Studio only if it is unable to reach me within a
reasonable period of time given the circumstances of the emergency. On behalf of
myself, my spouse and Participant, I forever release the Studio and its owners,
employees, independent contractors and other agents from any and all liability
related to the exercise of the authorization provided herein.
________________________
Signature of Participant
_______________________________
Signature of Parent or Guardian
_
Print Name of Participant
__________________________________
Print Name of Parent or Guardian
Please send this form with your 1st month’s tuition and registration fee to:
1665 Cheryl Way Aptos 95003