2020-2021 liability

Jul 06, 2022 12:12 PM

Liability Form 2020-2021

(student’s) NAME__________________________________________
( please Print )

The student / legal guardian agrees that Angela Vital-Martowski, (D/B/A The Dance Studio), agents, employees, and representatives shall not be held responsible for any injuries or illness sustained by the customer while dancing on the premises or for The Dance Studio off premises, from September 1, 2020 through September 1, 2021.
The student and/or legal guardian agrees to be video recorded and/or photographed during classes, rehearsals and performances. For use by the studio only. No photos/videos will be placed on an social networking site by The Dance Studio staff/teachers with out consent from the student/student’s guardian.
The Parent/ Student agrees to pay any tuition, costume and /or performance fees, to The Dance Studio, accrued during the above time frame . A Student/Parent must notify the studio at least 15 days prior to dropping a class/ studio activity. If the studio is NOT notified by the first day of the payment due date, the student/parent will be responsible for the tuition of that pay period, This includes costumes and /or fees in full. All payments are due the first week of each month. Any accounts more than 30 days past due will be subject to a $20 late fee.

Date _______________Sign _______________________________
( Legal Guardian/ student( if over 18yrs of age))

Date ______________Sign ________________________________
( Angela Vital-Martowski , D/B/A The Dance Studio)

_____ Yes, I would like to sign up for auto payment (deducted the 2nd week of every month)

Card number _ _ _ _-_ _ _ _-_ _ _ _- _ _ _ _ exp. _____/_______ CVV#__ __ ___

______No, I would not like to sign up for auto payment. I will pay in person or online on the first week of every month or in full for the year. A $20 late fee may be applied to any account more than 30 days late.