Credit Card Auto-Bill Form

If you would like the convenience of automatic recurring billing, please complete and sign this form. There are no additional fees for this service from AAD but you will have the bank service charges. It is OPTIONAL but highly encouraged. Please initial each statement and submit form to have all of your tuition charges AUTOMATICALLY charged to your credit card on the 1st of each month.

____ I understand that the full amount of tuition due on my account will be run on the 1st of every month (August 2018-May 2019), or if I start my auto-bill after the first month of classes, then the month immediately following its submission.
____ I am aware that if I’d like a copy of my statement of tuition, I can email the studio and request one.
____ My account is protected and only the studio owners have access to my information.
____ If I wish to cancel my auto-bill payments, I must request cancellation in writing with 10 notice before the next charge occurs.
____ My auto-bill will be cancelled and my card information deleted if my child drops out of his/her dance class, which I will notify the owners in writing with 10 notice before the next charge occurs.
____ Any refunds I am owed will be issued as a check, and not refunded to my credit card.
____ I understand if my card declines, there is a return payment fee.

Dancer(s)_____________________________________________________________________________
Parent Signature: ______________________________________________________________________
Parent Print: __________________________________________________________________________
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We will keep the following credit card information on file to pay your tuition each month. Please fill in each blank:
Name on Card:_____________________________________________________________________
Card #:_________________________________________ Ex: _________________ CVV:___________
Type of Card: VISA MC DIS Amount to be charged each month: $__________________
Billing Address: ________________________________________________________________________
City: _________________________________ State:_______________________ Zip: _______________

I do hereby hold harmless Amanda Ferreira, Amanda’s Academy of Dance/Fine Arts Foundation, and any/all teachers/instructors conducting classes at Amanda’s Academy of Dance/Fine Arts Foundation at 1 Park Place Haines City, FL 33844 from any injuries incurred or aggravated, any personal property lost, stolen, or damaged while at any dance classes, functions, or events involving Amanda Ferreira, Amanda’s Academy of Dance, and any/all teachers/instructors of Amanda’s Academy of Dance.

I hereby grant permission to Amanda’s Academy of Dance/AAD Fine Arts Foundation, Inc. to record my child’s name, voice, photograph, video, image, likeness, and performance(s) for advertisement and memory-sake on social media. I agree that the video/photograph or derivative video may be edited as desired and used in whole or in part for any and all broadcasting, streaming media, World Wide Web use, audio-visual, and or/ exhibition purposes in any manner or media, in perpetuity, throughout the world. I understand that I have no rights in the video or any benefits derived therefrom, and I acknowledge that there are no promises of compensation for participating in the production of videos/photographs taken this dance year. This consent specifically includes, but is not limited to, Amanda’s Academy of Dance/ AAD Fine Arts Foundation, Inc use of my child’s name, likeness, voice, image, and performance in connection with promotion of Amanda’s Academy of Dance/ AAD Fine Arts Foundation, Inc activities.
I hereby release Amanda’s Academy of Dance/ AAD Fine Arts Foundation, Inc and its employees from any and all claims, demands, causes of action, and suits, including, but not limited to, claims for invasion of privacy, defamation, breach of contract, or other breach of duty arising out of my child’s appearance in the videos and images that may be used throughout the dance year.
I represent that I have the right to enter into this Agreement and that my performance and the rights I have granted in this agreement will not conflict with or violate any commitment or understanding I have with any other person or entity.

• Dancers should enter the studio quietly and begin stretching. Parents please remain from entering the dance space unless otherwise requested. NO RUNNING IN THE STUDIO!!!
• Dancers should always be in uniform!
• Tuition & Registration fees are non-refundable.
• Cameras will only be turned on once a month.
• Costumes must be paid in full to be picked up.
• If costumes are not picked up within 30 days of arrival, they become property of the dance studio.
• After costumes go home, there is a 10 day window to make any exchanges in size.
• Any late tuition will have a $10 late fee.
• Dancers will treat all dancers as teammates in rehearsals, hallways, dressing rooms, classrooms and performances.
• Dancers agree to maintain a POSITIVE attitude.
• Dancers agree to put their name in all tights, shoes, and costumes!
• Parents and dancers will keep comments positive about performances, photographs, awards, etc.
- Any account that becomes delinquent will be sent for collections. Accounts that go to collections will be responsible for all attorney fees in addition to your delinquent account.