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I/We are the parent(s) and/or legal guardian(s) of the the student register under this account understand that dance is a strenuous physical activity. consequently serious injuries may occur. I/we will hold synergy dance academy, its entire staff and entities harmless for any and all claims by ourselves, our child or children, or others accompanying us arising from activities related to dance, the dance classes. use of or presence on the premises, or attending or going to or from the studio or event in other locations. I/We want our Child/Children under this account to fully participate with the knowledge that there is a substantial res of injury, I/We agree to accept and assume all the risk of injury, the cost to treatment, long term of life long affects, and other inconveniences and costs regardless of the seriousness go the injuries. I/We specifically release Kari Herman, Uri Yochelman and Synergy Dance Academy and all Synergy dance academy Staff members for all claims however arising, including but not limited to all physical and psychological damage.
I/We have read this release and understand and agree that by this release I/We accept complete and total responsibility for any injuries and costs of injuries to ourselves, our children, or anyone in our charge.
I hereby give permission for images and videos of my child/dancer, captured during classes, rehearsals, shows, competition, conventions, meetings, mixers and every studio assembly through video, photo and digital camera to be used solely for the purposes of synergy dance academy promotional material and publications including social media and waive any rights of compensation or ownership thereto.
I/we are over 18 year of age and read & understand the studio policies and agree to comply with and abide by all Synergy Dance Academy policies.
I hereby Authorise Synergy Dance Academy LLC to Debit agreed Monthly payment and/or any amount owed to the company for goods and services provided, This authorisation is to remain in force until Synergy Dance Academy LLC has received written notification of termination in such time and such manner as to afford Synergy Dance Academy LLC and /or the bank a reasonable opportunity to act on it (minimum of 14 days).
In the event that the company notifies the bank that funds transferred were not entitled to SynergyDance Academy LLC, I hereby authorise and direct the bank to return said funds to the referenced account.
I understand there will be a $25 fee automatically charged to ny account for any insufficient funds transaction
I understand and agree that All Auto pay transaction are non refundable
Late charges will incur a $25.00 late fee per pay period if not paid within 5 days of the due date. Please visit your portal regularly to make payments, or set up auto pay to avoid late fees.
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