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Hamden Academy of Dance-n-Music

Registration Form / Automatic Payment Consent Form/ Month Payment

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* All charges will appear on your bank on your credit card statement as Hamden Academy of Dance-n-Music.

I hereby authorize Hamden Academy of Dance-n-Music to charge my account the registration amount of $.I understand the school policies on the back of the form and agree to abide by them.


I/We the parent/guardian of hereby give my/our approval for to participate in any and all activities including but not limited to classes, trips, events given by Lia Davila individually and dba Ultimate Dance Experience/Hamden Academy of Dance-n-Music.

I/We assume all risks and hazards incidental to such participants including transportation to and from the activities; and I/we hereby waive, release, absolve, indeminify and agree to hold harmless lia Davilla individually and dba Lia's Ultimate dance Experience/Hamden Academy of Dance-n-Music, it's organizers and supervisors, participants a nd person transporting my/our child to or from activities, from any claim arising out of injury to my/our child, except to the extent and in the amount covered by accident or liability insurance.

I/We authorize any licenced physician to prove treatment, order injuctions, hospitalize, give anesthesia or perform surgery for I/We understand that the authorization is given prior to any need for medical care, but given to avoid unnecessary delay in emergency treatment that the physician may deem advisible in his/her exercise of best judgement. I presume a reasonable