ESPA Application 2022-2023

EMANJI SCHOOL OF ARTS

REGISTRATION AND AGREEMENT FORM

REGISTRATION FEE $20.00

"NO REFUNDS"

TUITION FEES:

Single Curriculum

$80 per month| $220 per term (3 months)

Mixed Curriculum

2 Curriculums - eg. dance+piano - $140 per month|$400 per term

3 Curriculums - eg. voice+circus+dance - $220 per month|$640 per term

Private Instruction

$120 per month | $340 per term

CURRICULUMS OFFERED:

*Dance - 2+ classes per week - Ballet, Ethnic, Tap, Jazz, Acrobatics etc.

*Drums - 2 classes per week - Practical Rudiments, Theory, Acrobatics

*Circus - 2 classes per week - Juggling, Trapeze, Basic Acro, Stilts etc.

*Drama - 2 classes per week - Acting Fundamentals, Improvisation, Articulation

*Acrobatics - 1 class per week - Tumbling Skills, Flexibility, Balance etc.

*Music - 1 class per week - Practical, Theory, Sight Reading, Ear Training

Piano
Voice
Instruments - eg. saxophone, trumpet, flute, etc.

(Tuition fees charged per music discipline)

Name of Applicant

Date of Birth

Date

Present Age

Female Male

Class(es) of Interest: (Check all that apply)

Dance Drumming Theatre (8 years and up) Piano ( 5 years and up) Circus (8 years and up) Voice (8 years and up) Acrobatics only (4 years and up) Instrument (7 years and up)

If ticked Which Instrument?

Day School Attended:

Present Grade:

Parent/Guardian Name

Relationship to Child

Address

Mailing Address

Email

example@example.com

Home Phone Number

Please enter a valid phone number.

Cell Phone Number

Please enter a valid phone number.

Work Phone Number

Please enter a valid phone number.

Does the applicant have any physical handicap?

Yes No

If Yes please explain

Is the applicant taking any special medication(s) we should know about?

Yes No

If Yes name Medication

In case of emergency please notify:

Phone Contact:

Give the name(s) of persons other than yourself, who will pick up the applicant:

Enrollment/Tuition / Liability Policy and Waiver

Please Read Carefully

In consideration of the benefits of the instruction provided by the EMANJI SCHOOL OF PERFORMING ARTS for myself, I do hereby enroll my child named above in the program and do acknowledge that there are no refunds for the registration fee or tuition fees. I understand that, if paying per month tuition is due on the 1st of the month. I do authorize emergency first aid care to said student by the school in the event he/she becomes injured or ill during instructional program or incidental sponsored activities either on or off premises. If the parents and / or guardian are not immediately available at the telephone numbers provided in the agreement, authorize the school, its staff or such agent to retain the services of a doctor of other competent medical person in order to treat the said minor. The EMANJI SCHOOL OF PERFORMING ARTS reserves the right to terminate a student's involvement in classes/shows if their behaviour or the behaviour of their parent or guardian is deemed unacceptable.

I acknowledge the contagious nature of COVID-19 and other contagious diseases and viruses and voluntary assume the risk that I and/or my children may be exposed to or infected by COVID-19 by attending and participating and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 and other contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, independent contractors, volunteers, and program participants and their families. I release The Emanji School of Performing Arts, its instructors, independent contractors and all associates from liability for harm, injury or death pertaining to COVID-19 and other contagious diseases and viruses.

I hereby release and agree to hold Emanji School of Performing Arts harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself, my child and/or property that may be caused by any act, or failure to act of the school, or that may otherwise arise in any way in connection with any services received from Emanji School of Performing Arts. I understand that this release discharges Emanji School of Performing Arts from any liability or claim that I, my heirs, or any personal representatives may have against the school with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Emanji School of Performing Arts. This liability waiver and release extends to the school together with all owners, partners, and employees.

Parent/Guardian's Signature

Clear

Date