I understand and authorize regularly scheduled charges to my checking/savings account or credit card on file. I will be charged each billing period for the total amount due for that period. A receipt will be emailed to me and the charge will appear on my bank or credit card statement. I agree that no prior notification will be provided to me for each scheduled payment.
I understand that this authorization will remain in effect until I cancel on the Parent Portal, and I agree to notify U Dance Studio in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment date falls on a weekend or holiday, I understand that the payment may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above stated periodic transaction dates. In the case of an ACH transaction being rejected for Non-Sufficient Funds (NSF) I understand that U Dance Studio may at its discretion attempt to process the charge again within 30 days, and agree to an additional $10.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card Company; provided the transactions correspond to the terms indicated in this authorization form.
I, ______________________, hereby agree to the following:
~I understand that there are risks of physical injury associated with, arising out of and inherent to the activity of dance. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/ or causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability could accrue U Dance Studio it’ officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities.
~ I hereby agree to release U Dance Studio and hold U Dance Studio harmless of all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury arising out of active participation in dance on behalf of the participant.
~I am aware that this is a release of liability and an acknowledgment of my voluntary and knowing assumption of the risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation.
~ I also give U Dance Studio permission to use mine and my child’s picture in or on any form of advertisement for U Dance Studio or a U Dance Studio affiliated event.
~If I am a minor, my parent and/or legal guardian has also signed this document releasing U Dance Studio from any and all such liability described above and has acknowledged that I am knowingly and voluntarily assuming all risks of injury inherent to this activity.
~This waiver applies to all members of the family associated with the Dance Studio Pro profile.
~ The participant has my permission to participate in U Dance Studio events. I warrant the below information is complete and correct. I further release U Dance Studio of all liabilities associated with mine or my child’s attendance at U Dance Studio.
Releasor Participant Signature
Parent/Guardian (for participants under 18)
**Please list any special medical instructions or comments: ________________________________________________________________________________________
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