You must be over 18 to register for an account.
I acknowledge, below with my signature, I have reviewed and understand the Policies and Procedures stated in the 2018-2019 F.I.R.E Expressions Performing Arts Conservatory information handbook. I will abide by these Policies and Procedures for the 2018-2019 Dance Session.
I grant to F.I.R.E. Expressions Performing Arts Conservatory, its representatives and
employees the right to take photographs/video of my dancer in
connection with the above-identified Event. I authorize F.I.R.E. Expressions Performing
Arts Conservatory, its assigns and transferees to copyright, use and publish the same in
print and/or electronically.
I agree that F.I.R.E. Expressions Performing Arts Conservatory may use such
photographs/video of my dancer with or without my name and for
any lawful purpose, including for example such purposes as publicity, illustration,
advertising, and Web content.
I understand that all payments are based monthly and should be paid the first class of each month. A $10 fee will be charged for payments received after the 10th of every month. Any child that has not paid within a week of payment due can not attend class until payment is made. I also understand that all fees paid are nonrefundable and nontransferable (if you have any questions, please see Leigha Porter). The parent or guardian is responsible for notifying, in writing, Leigha Porter and F.I.R.E Expressions of any change to the credit card or checking account. The NSF fee for returned checks is $25. Should this provision have to be enforced by legal means, the undersigned person(s) is responsible for payment, as liquidated damages, the costs of collection, plus interest at the legal rate and reasonable attorney’s fees as determined by the Court or 15% of the amount collected failing such determination.
RELEASE AND AUTHORIZATION
Name of Student: _________________________________________________
Indicated in the space below are any health problems or conditions of which the studio should be aware (such as heart, back, medical, allergy, muscular, pregnancy, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, herby waive and release Leigha Porter individually, F.I.R.E Expressions LLC. and it's staff from any and all claims or damages of any kind arising out of my child’s participation in the exercise and/or dance program of F.I.R.E Expressions LLC. I further certify that the aforementioned student is in proper physical condition to participate in the exercise/dance program and that he/she has been examined by a licensed physician and found to be in proper physical condition to participate in said program. I, the undersigned, do herby authorize Leigha Porter or her designated agents (being teachers or administrators employed by F.I.R.E Expressions, Inc.) to obtain medical treatment for my said child in emergency situations where I cannot be reached in time to authorize the treating physician to provide such emergency medical services. I understand that I am responsible for any medical expenses and that the absence of health insurance does not make Leigha Porter or F.I.R.E Expressions, Inc. responsible for payment of medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect for one year from the date signed below.
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