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Coastal Dance Studio
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Student's Name (1)
Student's DOB (1)
Student's Name (2)
Student's DOB (2)
Student's Name (3)
Student's DOB (3)
3-5 Year Olds
By checking this box, I do hereby grant permission to Coastal Dance Studio, Inc to use the image of my child. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Coastal Dance Studio, Inc Website. Grant permission to use my child’s image in the following way: Unrestricted usage: I give unrestricted permission for my child’s image to be used in print, video, and digital media. I agree that these images may be used by Coastal Dance Studio for a variety of purposes and that these images may be used without further notifying me.
A. LIABILITY RELEASE AND POLICIES
By checking this box, I understand that dance, taekwondo and related activity at Coastal Dance Studio, Inc may be dangerous and does or may involve risk if injury, loss, loss or damage. I further acknowledge that such risks may include but not limited to bodily injury, personal injury, sickness, disease, death, and property loss or damage, arising from the surrounding circumstances among others.
B.RELEASE AND INDEMNIFICATION AGREEMENT --
By checking this box,I hereby expressly assume all such risks of injury, loss, or damage to me, my child(ren) or to any related third party arising out of or in any way related to the activity at Coastal Dance Studio, Inc or other location business may be conducted at related to its activities, whether or not caused by the act, omission, negligence, or other fault of Coastal Dance Studio, Inc, it officers, its employees, its contractors, its volunteers, or by any other cause. I further hereby exempt, release, and discharge Coastal Dance Studio, Inc, it officers, its employees, its contractors, its volunteers, from any and all claims, demands, and actions for such injury, loss, or damage, arising out of or in any way related to Coastal Dance Studio, Inc activities.
C. PARENT/GUARDIAN MEDICAL CONSENT
By checking this box, as the parent or legal guardian, I authorize Coastal Dance Studio, Inc staff to render first aid to the above named minor child(ren) in the event of injury. Also, I authorize a licensed medical professional to examine this/these minor(s) and, in the event of injury, to render such care as he or she deems necessary for the treatment of such injury. I further authorize the Coastal Dance Studio, Inc to send this/these child(ren) to the hospital or licensed medical professional most accessible in the event of an injury or accident. I understand all related medical billing obligations are the responsibility of the parent or legal guardian.
By checking this box, I understand tuition is due by the 1st of each month, accounts not current by the 10th of the month will be assessed a $10 late fee. Students will not be allowed to participate in class if payment is not received by the 10th of the month. There is a $25 returned check charge for any checks returned by the bank. Monthly tuition is prorated over 10 months. We do not issue refunds for students who miss class or for scheduled studio closings due to holidays. I have received a complete list of studio policies which I have read and understand.
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