Hosanna Waiver 2024

Hosanna Dance Studio

Waivers for drop in or phone registration
FAMILY ACCOUNT INFORMATION
Participant Information*
Parent/Guardian's Name (Name on Account)*

First NameLast Name
Parent Email*
example@example.com
Primary Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (other than parent)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
MEDICAL WAIVER
By signing below, I hereby release Hosanna Dance, LLC, & their agents/representatives of liability for any injury to my child/ren (or myself) in class, on the campus, or while participating in Hosanna sponsored performances. In the event of an medical situation, I authorize a representative of Hosanna Dance to initiate necessary medical treatment. I understand that an attempt to contact parents/guardians/emergency contacts, will be made as soon as possible. I understand that my medical insurance carrier and I are financially responsible for any medical treatment extended to my child/ren (or myself) and that Hosanna Dance and its agents or representatives cannot be held accountable or liable for such medical treatment. *

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AGREEMENTS & PAYMENT INFORMATION
I understand that I am responsible to review all applicable policies and procedures as found in the Hosanna Dance parent manual, located in the studio office or online at http://www.hosannadance.com/studio-policies.html, and agree that my child/ren and/or I will adhere to all the guidelines therein.*

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I give Hosanna Dance and Mark Willett Photography permission to photograph and use images in print, videos, and web pages for promotional purposes. *

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Payment Information
Hosanna Dance LLC uses secure on-line payment processes for recurring payments. Credit card information will be held online by a secure processing server and will not be visible to Hosanna Dance staff. Recurring payments may be made via checking account with routing number, Visa, Mastercard, Discover, or Debit Cards (no American Express). Monthly tuition payments will be processed on the 5th of each month.
I choose to use Automatic/Recurring payment plan. I understand that Hosanna Dance will be billing me according to the terms of the season/class(es) for which I registered. Changes to my registration which impact the amount I will be billed are my responsibility to communicate with Hosanna Dance with at least 5 days notice before the automatic billing is scheduled. My non-refundable registration fee will be $65.00I choose NOT to use the Automatic Payment Plan and will pay via card, cash or check. I understand that Hosanna Dance does not send reminder invoices and that late fees apply to payments made after the applicable grace period. I will not receive the auto-payment discount on my annual registration fee. My non-refundable registration fee will be $90.00.I am registering only for My Buddy and Me, HD Fit, Short Session, or Summer classes. I understand that full payment for these classes is due at registration. I will not pay a registration fee to register for these classes, and there will be no automatic payments charged to my account for these classes. If I desire to take additional classes, I will register for future sessions.
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Hosanna Dance Studio

FAMILY ACCOUNT INFORMATION

MEDICAL WAIVER

AGREEMENTS & PAYMENT INFORMATION

Payment Information