ACADEMY OF DANCE & PERFORMING ARTS/ RELEASE FORM

 

Home Phone__________________

NAME OF STUDENT (please print)_____________________________________age______School________Grade______

 

         _____________________________________age_______School________Grade______

 

Address:____________________________________City________________________

 

Mother’s Name________________________Work Phone_____________Employer________

 

Father’s Name_________________________Work Phone_____________Employer________

 

Insurance________________________________________________________________

 

I confirm that the above student is in good health and has no restrictions as to activities. I assume all risks and hazards of the conduct of the program and release from responsibility any person providing transportation to and from activities. In case of Injury, I do hereby waive all claims or legal actions, financial or otherwise, against ACADEMY OF DANCE AND PERFORMING ARTS, the staff or their officials, or any volunteer connected with the program, unless injury is caused by the sole negligence of the parties named above. I give ACADEMY OF DANCE AND PERFORMING ARTS staff permission to call the Doctor-on-call in case of an emergency. In the absence of signature, payment of fees and participation the program shall constitute acceptance of the conditions set forth in the release.

 

Date:_______________________Signature_____________________________________

Of Parent, Legal Guardian or Adult Student

 

Studio Information Agreement

 

I have received and read all information in the 2009-2010 ADPA “Information Packet” and understand all class rules, class dress codes, and class tuition/payment schedules.

A $25.00 Costume deposit (for each class) is due at time of registration. If you choose to drop a class for any reason before December 1st, ADPA will gladly refund your costume deposit(s). If you for any reason decide to drop a class after December 1st (costumes will have been ordered) you will be responsible to pay for the balance of the costume(s) ordered.

 

Date:______________________Signature_____________________________________

Of Parent, Legal Guardian or Adult Student