Parental Consent Form
(Please initial next to each statement, acknowledging you read, understand and agree to the terms)
_____ Payment of tuition is DUE ON THE 1st of each month, beginning with August. Payments are divided into 10 months (August-May); there is no charge for holidays. Tuition fees may be paid in cash, venmo @Stacey-Bernard-1, Parent Portial, or check. Make checks payable to Stacey’s Dance Studio.
_____ If your tuition is not paid by the 15th of the month a $15.00 late fee will be added on the 16th of the month
_____ A $30 return check fee will be added on all NSF checks. All payments after an NSF check will be accepted by cash only.
_____ There are no discounts or refunds for absences.
_____ Sorry, no parents are allowed to stay in the studio during class time, unless it is parent observation day.
Allergies (Medication, Environment, Food, etc..)
____________________________________________________________________________________________________________________________________________________________________________________________________Medical Information we should know (ex. Asthma, ADHD, Diabetes)
____________________________________________________________________________________________________________________________________________________________________________________________________
____ Security: All individuals that enter the studio should be aware that we have security cameras that live stream audio and video signal in the studio. These cameras can record audio and video. These recordings are solely for security purposes and will not be available to the public. Surveillance videos and recordings will only be available to the studio owner, the police and to legal representative(s) in the event of a crime on or to studio property.
_____ Photo Release: By initialing here, I grant permission for photographs of my child in dance class or performances to be used in promotional material for Stacey’s Dance Studio in both print and web publications, including but not limited to the studio website and the studio's Facebook page.
_____ I agree that I am aware that my child named below will be engaging in physical exercise involving dance and fitness training which could cause injury to them. I agree that my child is voluntarily participating in these activities and is assuming all risks or injury that might result.
I HEREBY WAIVE, RELEASE, AND DISCHARGE Stacey’s Dance Studio and all divisions thereof of any and all liability and responsibility for injuries, sickness, pandemics, accidents, natural disasters and/or acts of God incurred during participation in and/or instruction of camps, intensives, private instruction, choreography or any activity I may participate.
I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Stacey’s Dance Studio and/or their directors, officers, managers, employees, volunteers, representatives, and agents, the activity or event
holders, activity or event sponsors, activity or event volunteers.
By signing this waiver, I hereby agree that I will not hold liable Stacey’s Dance Studio and/or all its instructors and /or property owners for any and all claims on account of any injury that might occur as a result of these activities. Staff of Stacey's Dance Studio will make no evaluation or recommendation whether my child is physically fit for any exercise activity. If my child has a physical condition affecting their ability to join these activities, I must provide Stacey’s Dance Studio with a doctor's note outlining any limitations. It is always advisable to consult your physician prior to undertaking any physical exercise program.
Parent’s Name: _________________________Dancer’s Name:____________________________
Parent Signature: _______________________________________ Date: ____________________
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