Dunamix Dance Project/Dunamix Athletics Medical Release/Waiver Form

                        

Dancer(s)/Athlete(s) Name/Age______________________________________________________

I, ___________________________________________________ understand that while dancing with Dunamix Dance Project or participating in PE classes with Dunamix Athletics, in class, rehearsal, or performing, my child may be at risk of physical illness or injury (minimal, serious, catastrophic and/or death) and I acknowledge that my child is assuming the risk of illness or injury by dancing with Dunamix Dance Project or participating in Dunamix Athletics. In the event of illness or injury, I authorize Dunamix Dance Project or Dunamix Athletics to obtain necessary treatment on my child’s behalf. I further acknowledge and understand that I will be responsible for any and all medical-related bills that may be incurred for any illness or injury my child may sustain while dancing with Dunamix Dance Project.        

Emergency Contact Name:______________________________________________________________

Emergency Contact Phone Number:_______________________________________________________

Doctor’s Name: _______________________________________________________________________

Doctor’s Telephone Number: ____________________________________________________________ Medications:__________________________________________________________________________

Allergies: ____________________________________________________________________

On behalf of my child, I hereby acknowledge that I have read this Medical Release/Waiver in its entirety and fully understand the contents. I am aware that this Medical release/Waiver exempts the liability of Dunamix Dance Project, Frank and Nicole Thomas, and all staff, and acknowledges my voluntary and knowing assumption of the risk of injury or illness. I have signed this document voluntarily and of my own free will.

                        

Parent Signature/ Date____________________________________________________________/_/_

                        

Authorization to Use Photographs/Videos                        

I, ____________________________________________, give Dunamix Dance Project/Dunamix Athletics the right to use photographs/videos of my child for promotional material.

                        

Parent Signature/ Date__________________________________________________________ __/__/__

Financial Agreement                        

I, ______________________________, understand that I am responsible for monthly tuition payments to Dunamix Dance Project. There are no refunds for missed classes, but I can make up classes within a 30-day period. I am aware that make-up classes expire once I drop a class unless I switch to another one. ____ initial  

In addition, I understand that if I drop a class I must submit a written cancellation notice on the studio’s Drop Form (see front desk) or by email by the 22nd or I will be charged for the following month's classes. ____ initial 

I am also responsible to pay in full, before the performance date, the recital and costume fees incurred if my child participates in the performances. ____ initial  In the event that my balance is 30 days overdue, I authorize Dunamix to charge my credit card on file for the balance due.____ initial

                

Parent Signature/ Date__________________________________________________________ __/__/__

           

Dunamix Dance Project/Dunamix Athletics          REGISTRATION FORM

                        

TODAY’S DATE: __________________

STUDENT’S NAME/AGE: ___________________________________________BIRTHDATE_________________

2nd STUDENT’S (sibling) NAME/AGE_______________________________BIRTHDATE_____________

STREET ADDRESS: __________________________________________________________________________

CITY: __________________________________________________    STATE ______________ZIP____________                                                      

PARENT OR GUARDIAN (IF STUDENT IS A MINOR):_________________________________________________

HOME PHONE NUMBER :___________________________________CELL: _______________________________

EMAIL:____________________________________________________________________________________

EMERGENCY CONTACT: name____________________________________phone #________________________

RETURNING STUDENT (ENROLLED PREVIOUSLY) : _____ (x)   # OF YEARS WITH DUNAMIX _______

NEW STUDENT : _______(x)

                                                

WHERE DID YOU HEAR OF DUNAMIX DANCE? ________________________________________________

                                                

PREVIOUS DANCE EXPERIENCE (# OF YEARS/WHERE) _______________________________________

                        

I, THE UNDERSIGNED, UNDERSTAND ACCORDING TO THE STUDIO POLICY THAT PAYMENTS FOR TUITION ARE DUE THE FIRST OF EACH MONTH'S CLASSES. I ALSO UNDERSTAND THAT THESE LESSONS ARE ON A CALENDAR MONTHLY TUITION BASIS AND THEREFORE CANNOT BE PRO-RATED. I UNDERSTAND THAT THE STUDIO DOES NOT OPERATE ON HOLIDAYS AND ON CERTAIN DAYS AS DETERMINED BY THE STUDIO SCHEDULE, WHICH CANNOT BE DEDUCTED FROM TUITION CHARGES. IN ADDITION, THERE IS A LATE FEE OF $15.00 IF TUITION IS NOT PAID BY THE 5TH OF THE MONTH. I UNDERSTAND THAT PAYMENT FOR ANY INJURIES IS THE RESPONSIBILITY OF THE STUDENTS AND/OR THE STUDENT’S PARENTS.

                        

Parent Signature/ Date____________________________________________________________/_/_

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OFFICE USE ONLY: FRONT DESK INITIALS _________  

$30.00 REGISTRATION PD. ______ CHECK#__________  CASH___________ CREDIT CARD_________