I have enrolled the above name student, in a program of strenuous physical activity through Spirit of Soul Dance Studio, Inc., and hereby affirm that the enrolled student(s) are in good physical condition, and do not suffer from any disability that would prevent or limit participation in this dance program. I hereby release Spirit of Soul Dance Studio (including the Artistic Director, Tracé Wilkins Francis, and any of her family or staff), from any liability now or in the future, including muscle strains, broken bones, knee/foot/lower back injuries, soreness or other medical problems, however caused, occurring before, during, or after participation in Spirit of Soul’s dance program, or any events/activities sponsored or organized by Spirit of Soul Dance Studio, Inc. By signing, I hereby affirm that I have read & fully understand and agree with the above waiver.
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By checking the box to the left and submitting this form, I hereby affirm that I have read & fully understand and agree with the above waiver.
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By checking the box to the left and submitting this form, I am indicating that I have read and understand Spirit of Soul’s policies and procedures and agree to follow them as documented. I also agree that I am financially committing myself to making timely installments during the 2009-2010 dance season.
Payment Options (please check one box):
Auto EFT monthly drafts from your checking/savings account.
Please click here for the auto-debit authorization draft form
Three installment payments via check, money order, cash or
debit/credit card (PayPal)
Semi-annual payments via check, money order, cash or
debit/credit card (PayPal).
Parent/Guardian’s name:
Date:
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