You must be over 18 years of age to register for an account.

Please review the registration documents, thank you!

Linden Dance Academy – Payment Agreement
I understand that a dance season is ten (10) months long, beginning in the first week of September and ending in mid-June. I understand that for my child to dance with Linden Dance Academy, I must pay for the entire ten (10) months of dance.

I understand that my tuition cost will be prorated if I begin dance later in the season and/or, if for any reason, upon thirty (30) days written notice, my dancer leaves the studio.

I understand that dance payments are to be paid on or before the first of the month, with a late fee of $20.00 to be posted on the 8th day of the month.

I understand that all dance fees, including tuition, costume fees, alteration, recital fees, etc. are to be paid in full before my child will be allowed to participate in recitals.

I understand that rates are per month and that rates will not be prorated based on vacation, absence or illness. Exceptions noted for hospitalizations and/or long-term illness.

I understand that there is a $30.00 fee for all NSF checks.

I understand that if my dancer is to compete in any competitions, they could be responsible for enrolling in summer classes to ensure competition readiness.

I understand that my dancer will be videotaped at rehearsal and recitals and that these recordings will be sold for general use, and that my dancer’s photograph may be used in promotional brochures and advertising in print and online.

I understand that I am not allowed to use flash photography and/or videotape performances staged by Linden Dance Academy, but that I will be allowed to photograph videotape rehearsals.

I understand that participation in ALL recitals is strictly voluntary. If my dancer is not going to participate, I must notify the studio in writing before the costume order deadline date in January. If I do not notify the studio in writing, I agree to be liable for any costume costs incurred on my dancers’ behalf.

Payment:
Payment options are viewed online through your Parent Portal account. Select one that best suits your situation. You may submit payment in person by check (made payable to LDA) or cash transactions will be accepted to avoid any additional fees.

$20.00 Registration fee PLUS the first month of tuition is due at the time of enrollment. This deposit will hold your space in the class of your choosing. Tuition payments will be required on or before the seventh day of each month throughout the semester to avoid the $20 late fee. ($20.00 registration fee/ $30 cap is required annually)


Name(s) of Dancer(s): _____________________________________________________________________________

Parent/Guardian Signature: ________________________________________________________________________

Printed Name:___________________________________________________ Date Signed:______________________

Linden Dance Academy
www.lindendanceacademy.com

Media Waiver Form
[photos | artwork | video | profiles | stories ]

Linden Dance Academy has my permission to use my child’s photograph, video, and audio recordings, likeness, artwork, profile and/or story in news publicity and any future publication, web pages and other promotional materials produced, used by and representing Linden Dance Academy. I understand the circulation of materials could be worldwide and that there will be no compensation to me for this use.

Student Name
Date
Parent or Guardian Name
Date
Print Parent or Guardian Name Phone #


Notes:_________________________________________________

Linden Dance Academy
www.LindenDanceAcademy.com

INFORMATION / MEDICAL RELEASE FORM
Complete a separate Enrollment Form for each student.

STUDENT INFORMATION (PLEASE PRINT)
STUDENT NAME
HOME PHONE
AGE DOB
ADDRESS
CITY/ZIP
INDIVIDUAL RESPONSIBLE FOR BILLING –

MEDICAL INFORMATION
STUDENT’S PHYSICIAN’S NAME PHONE
EMERGENCY CONTACT NAME
RELATION PHONE
IS THERE ANY MEDICAL CONDITION THAT YOUR STUDENT HAS THAT WE SHOULD BE AWARE OF? Y N

IF YES PLEASE EXPLAIN:

OUR GOAL IS TO SERVE AND EDUCATE YOUR STUDENT WITH THE HIGHEST QUALITY OF EDUCATION
POSSIBLE. IN ORDER TO DO THAT WE NEED TO KNOW IF YOUR STUDENT HAS ANY LEARNING DISABILITIES.
WE WOULD LIKE TO ADAPT YOUR STUDENT’S CLASS CURRICULUM SO THAT THEIR LEARNING EXPERIENCE IS
AS BENEFICIAL AS POSSIBLE. PLEASE LIST ANY CONCERNS :


MEDICAL COVERAGE/AUTHORIZATION FOR SUBSTITUTED CONTENT
I certify that I or my child is covered by a personal family medical plan, health insurance, or an HMO that includes coverage for injuries sustained while student is participating in any of Linden Dance Academy classes, rehearsals, performances, activities, or programs sponsored by LDA. LDA will not be responsible for any costs or liabilities resulting from a lack of such coverage.

I hereby grant permission to the director of Linden Dance Academy, or anyone designated by the director, and to those persons listed above as emergency contacts to authorize emergency medical or surgical treatment, including but not limited to, blood or blood product transfusions, diagnostic procedures, and the administration of anesthesia, for the student where medically appropriate in the case of injury, accident, or illness; subject however to the following limitations:

This authorization is given for the benefit of the student. The authorization given to the director is given with the understanding that the director or the director’s designee will act only in my absence and only until, I, my spouse, the legal guardian, or persons designated above can be contacted. I do understand that the medical appropriateness of such treatment will be determined by the attending physician or the medical facility’s medical staff and that such a determination shall be conclusive evidence of the reasonableness of the consent given. I agree to hold the director, anyone designated by the director, and any LDA employees harmless from liability arising from any and all medical treatment, or complications arising there from, rendered as a result of consent given pursuant to this authorization.

I further authorize the release by LDA or persons listed above to the health care provider of such medial personal information as LDA or persons listed above may have regarding the student and the use of such information by the health care provider in the subsequent medical treatment of the student. I have read Linden Dance Academy rules and regulations, and I understand that complying with these policies will help my child and the school to grow successfully.


Signature: