One form per student.
Print & Mail to: Ronnie’s Academy of Dance
1598 N. Meadowcrest Blvd
Crystal River, FL 34429
Primary Adult _________________________________ Mailing Address _________________________________________
City ________________________________State _____ Zip _________ Phone ( ) ________________
Work Phone ( ) _______________________________ Cell Phone ( ) _____________________________
Student Name ____________________________________ Sex_____Age _____ Date of Birth_______________Grade______
Email Address: __l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l__l
(for Ronnie’s Academy of Dance business only)
AGREEMENT TO PARTICIPATE AND LIABLITIY WAVIER: I understand dance and related activities involve risk of injury. I, the adult applicant or parent or legal guardian of the student listed above, hereby give approval for the student’s participation in any and all Ronnie’s Academy of Dance programs and activities as registered. I waive, release, absolve, indemnify and agree to hold harmless the organizers, sponsors, supervisors, participants and persons involved in the operation of Ronnie’s Academy of Dance (it’s owners, staff and related parties) programs for any claims arising out of injury or other loss to named applicant or any member of his/her family whether as a participant in the activities or as a spectator or visiting the facilities. I further understand Ronnie’s Academy of Dance is not liable for children left unattended when not participating in a class. AUTHORIZATION OF MEDICAL CARE: In case of injury or illness while participating, I authorize medical care for myself or child and accept responsibility for medical expenses. PHOTO AUTHORIZATION: I also give permission for Ronnie’s Academy of Dance to take photos of me or my child to use for the purpose of promoting the school. If any child exhibits behavior that is dangerous to herself/himself or to other students, Ronnie’s Academy of Dance reserves the right to remove the child from the school. POLICIES AGREEMENT: I have read, understand and will abide by the policies & rules above, as well as those listed in the Ronnie’s Academy of Dance brochure and the registration letter attached, including no refunds on tuition or costumes paid.
__________________________________________________________________ _______________________________
Adult Student or Parent/Guardian Signature Date
How did you hear about us? Yellow Pages___ Friend___ Newspaper Ad___ Other_____________________________
New student registration fee $25.00 - Returning student registration fee $10.00
Ronnie’s Academy of Dance reserves the right, at any time, to cancel or change classes, days and times.
Total Deposit Enclosed $ __________ No Post Dated Checks - Returned check fee: $15.00 **NO REFUNDS **
Late Fee Policy: If one half (1/2) of a 10 week pay period balance is not paid by the 5th week or if the total balance is not paid by the 10th week of that pay period, a $10.00 per week late fee will accrue until the balance is paid in full.
