By checking below, I certify that I am over the age of 18 and the parent/legal guardian of the student(s) listed in this account. As the primary account holder, I understand that I am the one ultimately responsible for the timely payment of all fees associated with this account, including but not limited to, tuition, fees, costumes, and any merchandise charged to your account by yourself or your student(s).

I hereby release, discharge and forever acquit Columbia Dance Academy, its respective agents, directors and employees of any and all liability, claims, demands, actions and causes of action whatsoever, arising out of, or related to, any loss, damage or injury, including death, that may be sustained by me or any participant in, person at, or to the property of myself while either participating in or being present at Columbia Dance Academy, including, but not limited to, those injuries and damages caused by negligence whether it be active or passive, or ordinary on the part of Columbia Dance Academy, and its respective agents, affiliates, directors and employees arising from the undersigned while participating in or being present at Columbia Dance Academy. This release shall be binding upon assignees, distributes, heirs, next of kin, executors and administrators of the undersigned and may be pled by Columbia Dance Academy in any complete and defense against any claim, demand, action by or on behalf of the undersigned.

By execution of this release, I hereby acknowledge and expressly represent that:

I am duly aware of the risks and hazards inherent upon entering the Columbia Dance Academy studios for rehearsals or Columbia Central High School for rehearsals or performance;

I elect voluntarily to enter, participate or be present at all rehearsals and performances possible;

I have read the foregoing release, understand it and sign it voluntarily.

In the event that a parent or emergency contact cannot be reached, I hereby give permission for any staff or faculty member of Columbia Dance Academy to seek medical attention for my child(ren) enrolled in classes at Columbia Dance Academy.