Tammy’s School of Dance
Tammy Simmons, Gabby Howell, Deanna Williams, Instructors
PLEASE FILL IN ALL FIELDS AND PRINT CLEARLY:
This agreement must be completed in full before any participant may begin
Activities.
Full name of Minor:_____________________________________________________________
Full name of Parent/Legal Guardian:________________________________________________
Relationship:_________________________ Grade Level/Age_______________________
Address of Minor:_______________________________________________________________
Address of Parent/Guardian (if different):____________________________________________
Ph #:_____________________________
Email: (Must be included for invoicing/newsletters)________________________________________
Debit Card: (MUST be included in case of non-payment through out the year)
____________________________________________Exp.______________________________
3 digit code___________________________ Name on card______________________________
Zip code______________________________
Emergency Contact:_______________________ Emergency Contact Ph #:______________________
An pertinent medical information we may need to know such as allergies, physical limitations, medical
problems, etc._______________________________________________________________________
__________________________________________________________________________________
PLEASE READ CAREFULLY, THIS IS A LEGAL DOCUMENT
WARNING: BY SIGNING THIS AGREEMENT, YOU WILL GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE
RIGHT TO SUE TO RECOVER COMPENSATION FOR ANY ACCIDENT, INJURY, LOSS OR DEATH TO YOURSELF
ARISING OUT OF YOUR PRESENCE AT ANY TAMMY’S SCHOOL OF DANCE ACTIVITIES.
I, __________________________, Parent or Legal Guardian of ___________________________ (the “Minor”)
hereby acknowledge and agree to the following:
In consideration of participation in any and all TAMMY’S SCHOOL OF DANCE classes, activities,
events, performances, rehearsals or practice sessions (collectively “Activities”), I hereby release,
waive, and discharge TAMMY’S SCHOOL OF DANCE their affiliates, members, officers, directors,
shareholders, employees, coaches, instructors, volunteers, agents, independent contractors, the
landlord/owner of the buildings (collectively, the “Released Parties”) from any and all liability,
actions, causes of action, suits, debts, statutory obligations, sums of money, claims and demands
of every nature and kind whatsoever, at law or in equity, which I/ or the Minor ever had, now
have, or which I/ or the Minor may at any future time have against the Released Parties, or any
one or some of them, arising out of or in any way connected with the Minor’s participation in any
Activities, including claims that allege negligent acts or omissions of the Released Parties, or
claims arising from any statute.
I agree to indemnify and/or totally compensate the Released Parties from and against all Claims
arising as a result of the Minor participating in any activity at or on the premises of the Activities.
I agree to pay for all legal fees that are incurred as a result of any Claims made by me or on my
behalf, or on the Minor’s behalf or that are otherwise related to or caused by my or the Minor’s
actions or inactions.
I understand that by signing this Agreement, I am giving up the right to sue or make any Claim
against the Released Parties on my behalf or on behalf of the Minor, and that this Agreement shall
be binding on the heirs, executors, administrators, assigns, and personal representatives of
myself or the Minor.
If any portion of this Agreement is held invalid, I agree that the remainder of the Agreement shall
remain in full legal force and effect.
I appreciate that this Agreement applies whether the Released Parties are at fault or not and it
limits the liability of all of the Released Parties, notwithstanding that not all of the Released
Parties are formal parties to this Agreement. I understand that TAMMY’S SCHOOL OF DANCE in
securing execution of this Agreement by me, is acting as agent or trustee on behalf of or for the
benefit of the Released Parties, who shall to this extent be or be deemed to be parties to this
Agreement.
I am aware that participation in the Activities has possible risks, dangers and hazards, and accept
same entirely at the Minor’s own risk. I understand that the risks associated with that use
include, but are not limited to:
• injuries resulting in muscular or soft tissue injuries including sprains, strains, bruises,
scrapes, cuts, etc.;
• injuries resulting from the failure to properly use equipment or follow instructions;
• risk of experiencing fatigue, dizziness, fainting, etc. as well as the potential risk of
further injury as a result of the above;
• injuries that may result from transportation accidents to and from the Activities.
I acknowledge that the above list is not inclusive of all possible risks associated with the Activities
and in no way limits the extent or reach of this assumption of risk, release of liability, and
indemnification. I understand that no amount of care, caution, instruction or expertise can
eliminate the inherent dangers associated with the Activities.
I agree that the Released Parties are not responsible in the event of loss, damage, unauthorized
use, theft, or injury resulting from and to any personal property that the Minor brings to the
Activities.
I agree that the Minor will read and ensure that the Minor understands the rules of TAMMY’S
SCHOOL OF DANCE, and that the Minor will abide by those rules, or others given during any
Activities.
I understand and agree that my tuition will be paid promptly at the first class of every month either by
electronic draft, check or cash. If my tuition is not received by the first class of the month, unless other
payment arrangements have been made, late fees may occur.
If at any time I voluntarily withdraw my membership, TAMMY’S SCHOOL OF DANCE is
under no obligation to refund any part of tuition. All costume payments are non-refundable.
I hereby authorize TAMMY’S SCHOOL OF DANCE to publish photographs, videos, or any
other form of media taken of the Minor during any Company workshop, class, or any other
event, and the Minor’s likeness, (the “Media”) for use in TAMMY’S SCHOOL OF DANCE
print, online, and video-based marketing materials, as well as other Company publications or
marketing (the “Publications”). I hereby release and hold harmless TAMMY’S SCHOOL OF
DANCE from any reasonable expectation of privacy or confidentiality associated with the
Media.
I have read and understood this Agreement and am executing this Agreement freely and
voluntarily without any compulsion on the part of the Released Parties. I understand that this
Agreement contains a promise not to sue the Released Parties and provides for a release and
indemnity for all Claims.
Intending to be legally bound, I have signed this _________ of ________________, 20______.
Signature of Parent/Legal Guardian Printed Name of Parent/Legal Guardian
_________________________________________________. _______________________________________________