Registration Form / Automatic Payment Consent Form/ Month Payment
* 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
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