Registration - Hi-5 Early Learning Center (Academy Road)

Registration Form - Hi-5 Early Learning Center (Academy Road)

Student Information

Student Name

DOB

Nickname (if preferred to be addressed by)

Any pertinent medical information you think I should be aware of

Responsible Party Information

Please select an option below

If responsible party is 18 years old or older and registering his/herself, please check this box

If the responsible party is registering on behalf of someone else or a minor, please check this box

Registering Party Name

Relation to Student

Phone Number

Email Address

KADC Policies

Tuition: Tuition is to be paid in full by the second class of each eight-week session. Classes are not prorated. All tuition is non-refundable. Tuition is $120/registered student for each 8-week session registered.
Payment: Payment can be made by cash, credit/debit card or check made out to “Kelsey Anne’s Dance Connections” upon receipt of invoice.
Returned Checks: Returned Checks are charged $20 for additional handling. A second returned check requires future payments to be made in cash or money order in advance.
Withdrawal: Withdrawal from KADC programming does not financially affect the registered student. However, program tuition will not be refunded.
Emergency Cancellations: Should inclement weather or a personal emergency take place for KADC instructors, a make-up class will be scheduled at a later date to ensure all participants receive their full eight-week programming. Kelsey will be in contact with registered students’ families via email regarding the need for cancellations and make-up classes.
Regular Attendance: Regular attendance to each class held within a KADC program is strongly encouraged for all registered students to continue to progress in their knowledge and skills. A prorated tuition is not available for absences due to short-term illness or personal conflict resulting in missed classes. However, if the registered student experiences a prolonged illness or life event preventing them from attending their registered programming, please reach out to Kelsey to discuss further make-up options.

Release of Liability

I am aware the nature of dance programming may carry with it the risk of physical injury and transmission of illnesses. On behalf of myself/child I have registered for this dance class, I assume these risks and agree that neither Kelsey Anne's Dance Connections, LLC (KADC) or KADC staff shall be liable for any injuries/illnesses sustained during attendance of KADC provided classes.

Agreement: I, the parent or guardian of the above named student (or the student, 18 years old or older, registering themselves) have read, understand, and fully agree to abide by these stated policies, and agree to registration based upon these conditions and policies as they pertain to the KADC Policies and Release of Liability Waiver

I agree

In the event of an emergency, please contact the following person(s) in the order presented.

Emergency Contact

Contact Relationship

Contact Telephone

Enter any additional emergency contacts here

Please select an option below

If responsible party is 18 years old or older and registering his/herself, please check this box

If the responsible party is registering on behalf of someone else or a minor, please check this box

I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.

I agree

PARENT / GUARDIAN WAIVER FOR MINORS In the event that the participant is under the age of consent (18 years of age), then this release must be signed by a parent or guardian, as follows: I HEREBY CERTIFY that I am the parent or guardian of the registered participant and do hereby give my consent without reservation to the foregoing on behalf of this individual.

I agree

Photo/Video Release Form-KADC Keepsake Video & Social Media Use

I hereby grant and authorize KELSEY ANNE’S DANCE CONNECTIONS, LLC the right to take, edit, and distribute pictures and videos of the registered dancer for both of the following reasons: 1) so my registered dancer may be included in the KADC Keepsake video sent out to registered families at the end of each 8-week session, and 2) so that pictures and videos taken during this current 8-week session may be utilized in social media postings promoting KADC dance class offerings.

I agree to the KADC Photo/Video Release Form

Yes

Entering your name and today's date below constitutes a digital signature. By signing below, you agree to all of the above policies.

Signature

Date