Medical/Liability Wavier

Medical/Liability Wavier
School of Dance & Gymnastics 210 Moseley Rd Byron, GA 31008

Medical and Liability Release Parent/Guardian's Agreement
Students First & Last Name
Age
Date of Birth

MonthDayYear
Date
Sex
Student's Address
Father/Guardian Information

First NameLast Name
Address
Phone Number
Mother/Guardian Information

First NameLast Name
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
The child named above will be permitted to take part in dance and gymnastics activities offered by Ms. Patricia's. I/We release Ms. Patricia's School of Dance & Gymnastics, proprietors, instructors and sponsors from any liability of above student, to us, or to either of us as parents/guardians for injury to above student and further agree to indemnify Ms. Patricia's School of Dance & Gymnastics, proprietors, instructors and sponsors against all loss and liability which they may incur or become responsible for, arising by virtue of above student's participation in such activities and athletics.
Parent/Guardian Signature
Date

MonthDayYear
Date
Signature of ParentGuardian
I/We have completed all registration, medical & liability release forms.
Date

MonthDayYear
Date
Person Responsible for Tuition
Emergency Contact(s) other than Parent or Doctor
Name
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Photography Waiver
I am granting permission for my child to be filmed, videotaped, audiotaped or
photographed and are granting full use of the likeness, voice, and words without
compensation.
I have read and understood this waiver and affix my name in agreement.
Please Type Your Child’s Name and Your Name As Proof Of Signature and Acceptance of
this Release Form:
Child's Name

First NameLast Name
Parent or Guardians Signature
Date

MonthDayYear
Date
Tuition is due by the 10th of each month. After the 20th, a late fee of $25 will be due. If not paid by then, the student will not be allowed to attend until the account is current. If not paid, the balance due will be turned over to a collection agency.

Email
example@example.com
Payment Agreement
I understand and agree that I am financially responsible for the payment of all services related in the amount stated below. I agree to pay the full amount in the time period as stated below. I understand that any remaining balance not paid in full will accrue a late fee and that continued non-payment will result in delinquency and the dismissal of the student from all classes as well as the termination of service.
For professional services listed below, I agree to pay Ms. Patricia's School of Dance and Gymnastics on a monthly basis, with payment due on the 10th of each month at a rate of:

DanceGymnasticsCheer
Student Name:

First NameLast Name
Parent Name:

First NameLast Name
For the duration of this agreement as specified below:
Fall Classes (Aug/May)
Summer Classes (June/July)
Start Date

MonthDayYear
Date
End of Service Date

MonthDayYear
Date
I understand that during the term of this agreement, fees for costumes and performances, including but not limited to competition, recital, festivals, and other such scheduled performances will be charged in addition to tuition fees, and that non-payment of these fees will result in the same delinquency as stated below.

Payments shall be deemed delinquent if not received by the 20th of each month. If any scheduled payment related to this agreement is deemed delinquent during the term of this agreement, the agreement shall be considered in default, and a late fee of $25 shall be applied to each delinquent payment in addition to any and all accrued dues. At the accrual of three months consecutive delinquency, students will be dismissed from classes and services discontinued until payment is received.
Client Signature
Date

MonthDayYear
Date
Witness Signature
Date

MonthDayYear
Date
Should be Empty:

Medical/Liability Wavier

Emergency Contact(s) other than Parent or Doctor

Photography Waiver

Payment Agreement