Pre-Register Today!
Print a copy, fill it out and send to:
Miami Valley Dance Academy
PO Box 227 Waynesville, OH 45068.
Please include your $20.00 registration fee.
Make checks payable to Miami Valley Dance Academy or M.V.D.A.
Thank you!
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Miami Valley Dance Academy Registration Form Student's Name _________________________________________ Date of Birth __________________________________________ Address _______________________________________________ City/State ____________________________ Zip______________ Parent(s) or Guardian(s) ___________________________________ Home and/or Cellular Phone # ______________________________ Emergency Name and Phone # ______________________________ Email Address ___________________________________________ Are there any medical conditions we should be aware of? (If so, explain) __________________________________________________________ __________________________________________________________ Consent/Release Waiver Activities such as dance, gymnastics, cheerleading, and Zumba Fitness may carry a risk of injury to the student. Some of these risks include, but are not limited to, injuries such as bruises, broken bones, torn ligaments, dislocations, muscle pulls, etc. We, the staff of the Miami Valley Dance Academy, do everything we can to reduce the risk of accidents and injuries to participating students. It is with this understanding that I enroll my child/myself into a program at M.V.D.A. If the need for medical treatment for my child/myself arises, I do hereby grant authority to any of the staff of the Miami Valley Dance Academy to transport or obtain transportation to the nearest hospital or treatment center. I further agree that, due to my understanding of the inherent risks involved, the owners and instructors who work with my child/myself shall not be held liable for any damages arising from personal injuries sustained by my child in or about the dance/tumbling area. I hereby fully release and discharge the Miami Valley Dance Academy owners and instructors from any and all claims, demands, damages, rights of actions, present and future. Tuition Tuition is due at the beginning of each month. A grace period will be given. After the 15th of the month, a $5.00 late fee will be applied. Tuition remains the same whether it is a long, 5-week, or short, 3-week month. A make-up class will be scheduled if classes fall under 3 weeks/month. If a make-up class is unavailable, a credit will be given. Credits will not be given for personal absences. Please Read and Sign Below I, the undersigned parent/guardian or student, have read and fully understand the above policies of the Miami Valley Dance Academy and agree to abide by them completely. Parent or Guardian signature___________________________________Date____________________ Student's signature (18 and older) ___________________________________ |