Liability Release Form
(Please initial and sign the following)
_______I, (Parent/Legal Guardian) ___________________________________ release Artistry Dance Complex, located at 562-564 Broadway, Massapequa, NY 11758, its officers, staff, owners, faculty of any liability for accident or injury that may occur while attending dance class, or any other related activities away from or at the facility where Artistry Dance Complex may be holding performances and/or demonstrations.
_______I understand in the event of a medical emergency / injury I shall be contacted immediately and in the interim, I hereby authorize the staff of Artistry Dance Complex to take any steps necessary to provide medical services until such time I can be reached / arrive.
_______I further understand and agree that the staff of Artistry Dance Complex may administer simple first aid to my child in the event of minor injuries, and I will be contacted at the time of incident.
_______I agree to assume all risks associated with participation in dance instruction, and related activates.
_______I acknowledge that, (Student Name): _______________________________, is covered under an adequate insurance policy.
_______I release Artistry Dance Complex, officers, staff, owners, faculty of all injury, medical bills, loss of personal items, occurring in or around the studio premises or at any functions held at other locations in connection to dance classes.
_______I understand that I am responsible for chaperoning my child when on the premises when classes are not in progress.
I understand that Artistry Dance Complex takes no responsibility for children that are not students and are not in a supervised class with a teacher.
I have read and understand the “Liability Release Form” and agree to abide by them as stated above.
Parent/Guardian Name: ________________________________________ Date: ______/______/______
Parent/Guardian Signature: _____________________________________
Student(s) Name: _______________________________________________
Emergency Contact and Phone Number: __________________________________________________
Parent Consent Form
(Please initial next to each statement, acknowledging you read, understand and agree to the terms)
_______Payment of tuition is DUE ON THE 1st OF THE MONTH. Payment of tuition secures enrollment for your child in class. We do send statements monthly.
_______You have until the 10th of each month to pay tuition. On the 11th, we will add a $20 late fee, unless we have received a “Withdrawal” form or written notification dropping the child from class prior to the 1st of the month. NO EXCEPTIONS!
_______TUITION REMAINS THE SAME EACH MONTH REGARDLESS OF WHETHER IT IS A 5-WEEK MONTH OR A SHORTENED MONTH DUE TO HOLIDAYS. Tuition is not pro-rated, refunded or credited for missed classes, vacations, or holidays. Any student who misses a class may make-up classes in other classes that are comparable for their age/skill level.
_______If your child is absent due to any reason: illness, vacation, or other activities, payment is STILL due by the 10th to continue to hold the spot in class for your child. There are NO REFUNDS for missed classes.
______If your child is no longer taking classes, a “Withdrawal” form must be completed or notification in writing is required before the start of the next month. Any outstanding fees on the account must be paid in full upon un-enrollment. Failure to turn in a “Withdrawal” form will result in continued tuition charges and late fees, until we receive a completed form or letter.
_______A $25 return check fee will be added on all insufficient fund checks.
_______If you are not available to pay in person, please either call the studio for payment over the phone or mail your tuition to avoid late fees.
_______All accounts must be completely paid off by May 10, 2021 for dancers to be able to participate in the end-of-the-year recital.
_______I understand that no student will be admitted in class without a signed registration and liability form.
_______PHOTO RELEASE: By initialing here, I give permission for photographs of my child in dance class or performances to be used in promotional material for Artistry Dance Complex’s in both print, video, and web publications. I understand that students will not be compensated in any way for use of these photographs and that student’s names will not be used without additional consent.
By signing below, you are acknowledging that you have read and understood all policies & procedures, tuition policy, and fees associated with dancing at Artistry Dance Complex
Parent/Guardian Name: ________________________________________ Date: ______/______/______
Parent/Guardian Signature: _____________________________________
Student(s) Name: _______________________________________________
2024 Registration Form
Student(s) Name (Print clearly)
Parent/Guardian
Age Birthday Grade in September
Street Address City, State Zip Code
Home Phone Work Phone
Cell Phone (Parent) Cell Phone (Student)
E-mail Address (Parent) ***REQUIRED***
Does you child have any allergies?
Emergency Contact Relationship Phone Number
How did you hear about ADC?
Please indicate your class preferences by checking below:
☐ Tap ☐ Ballet ☐ Combo I or II ☐ Lyrical
☐ Hip Hop ☐ Pointe ☐ Preschool ☐ Musical Theater
☐ Jazz ☐ Modern ☐ Contemporary ☐ Acro/Pom
Payments accepted: Cash or Checks/ Card through Portal only.
OFFICE USE ONLY:
Student Name: _______________________________________________________________________
Fall Tuition: ___________________________________________________________________________
Total Amount Paid: ___________________________________________________________________
FORM OF PAYMENT: Cash: _____________________ Check #______________________________
***ALLERGIES*** ______________________________________________________________________
NOTES: ______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
