POLICIES & PROCEDURES AUTHORIZATION
This form is to authorize CenterStage Dance LLC (1920 South Main Suite 105, Stuttgart, AR 72160 ,their agents, representatives and employees hereafter “the schoolâ€) to obtain medical assistance and to provide transportation for the student herein below named, and to release “the school†from liability for injuries to the student while on school premises or otherwise in the care of school staff members, such as transporting the student.
In the event that I, the parent/guardian cannot make arrangements for emergency medical attention at the time of illness or accident of my child, I hereby authorize “the school†to take my child to a doctor or hospital, where medication or medical procedures they may deem necessary for my child’s well being will be administered. The undersigned further agrees to be financially responsible for all such medical services, including the cost of defense and enforcement of this indemnity agreement.
I further understand and agree that “the school†may administer simple first aid in the event of minor injuries, and family members or doctors will be called when in the discretion of “the schoolâ€, it is necessary.
I/We represent that I am parent/guardian of the child named below and I am fully responsible for the care and well being of the child. I agree that “the school†shall not be liable for any damages, claims or compensation of whatever nature (including liabilities for negligence, strict liability, or otherwise) that may arise to me or for my benefit, in the name of or for the benefit of any other person as a result of my personal injury to the child named below while on premises of the school or otherwise in the care of “the school†including any such injuries sustained while the child is being transported as herein authorized and hereby agree to indemnify and hold harmless “the school†and servants, whether paid or volunteer, against any and all claims which any arise from any injury to said child while participating in or being transported to programs of ’the schoolâ€. Provided, however, “the school†shall be liable for injuries resulting from gross negligence of “the schoolâ€, or injuries intentionally inflicted by “the schoolâ€.
I/We acknowledge that my child will be video-taped or photographed for educational or performance purposes. I/We ______GIVE _______ DO NOT GIVE permission for ‘the school’ to post videos and/or pictures on ‘the school’ website and/or social media accounts.
I/We understand that Monthly tuition is due on the 1st of each month. That tuition remains the same whether it’s a long (5 week) or short (3 week) month and regardless of absences, vacations or holidays. I also understand that a $20.00 NSF or LATE fee will be assessed to my account if the monthly payment does not clear or if payment is not received by the 10th of each month.
I/We understand that in order to withdraw from CenterStage Dance, written notification is required before the 1st of the upcoming month to avoid further billing, and also understand that tuition is due for the month in which you drop. A two month minimum is due on all classes in which registration is completed.
I/We understand that payment for costumes of approximately $65/each (costume prices may vary) will be collected half in September and half in November. A production fee of $50/student will be collected in March.
I have read the foregoing Tuition/ Registration Policies and Medical/Transportation Release and agree with it in all respects.
THIS ABOVE SIGNED DOCUMENT DOES NOT COVER CHILDREN THAT ARE VISITING THE STUDIO PREMISES OR ARE NOT IN CLASS. ALL CHILDREN SHOULD BE CHAPERONED AT ALL TIME WHEN NOT IN CLASS OR VISITING STUDIO. WE ARE NOT RESPONSIBLE FOR CHILDREN THAT ARE NOT OUR STUDENTS AND ARE NOT IN A SUPERVISED CLASS WITH A TEACHER.
WE RESERVE THE RIGHT TO ASK CHILDREN OUT OF CONTROL WHILE AT STUDIO TO LEAVE ALONG WITH PARENT / GUARDIAN.
I HAVE READ THE ABOVE STATEMENT AND AGREE TO THE STUDIO RULES STATED AS SUCH.
