PLEASE READ THIS SECTION CAREFULLY! IF YOU DO NOT WISH TO CONSENT TO ELECTRONIC SIGNATURE, DO NOT PROCEED WITH THIS ONLINE REGISTRATION. PLEASE COME TO ONE OF OUR PHYSICAL LOCATIONS TO REGISTER IN-PERSON USING PAPER REGISTRATION.
This authorization consents communication electronically in the submission of forms and documents related to enrollment and participation in THE DANCELIFE CENTER, LLC ("DanceLife") programs. If you are enrolling multiple participants, this consent is valid for all students enrolled.
In order to access and communicate electronically through this system, you will need to have a smartphone, tablet, or computer that can access and submit information through the Internet.
By checking the box below, you are: (1) consenting to communicate electronically with DanceLife with regard to enrollment and participation in DanceLife programs; (2) authorizing DanceLife to send you notices, disclosures, and forms electronically, and agreeing that information and responses that you provide to DanceLife may be stored in electronic format; and (3) agreeing that your electronic signature on an electronic authorization or agreement will serve the same purpose as a written signature.
If you consent to electronic communications but change your mind later, you may withdraw consent for further electronic communications by submitting written notice of your withdrawal by hand delivery or by U.S. mail addressed to The DanceLife Center, P.O. Box 776, Charleston, IL 61920. Your withdrawal shall be effective upon notice of receipt from one of The DanceLife Center coordinators. Please note that electronic communications, submissions, and signatures made prior to the date of withdrawal remain effective following withdrawal.
Your decision to decline or withdraw consent to electronic communications will have no impact on the enrollment of your student(s) at DanceLife.
By registering online, you are automatically signed up for e-payment and you are authorizing DanceLife to use the account information for all of your account billing (including registration fee, tuition, performance fees, late fees, recital fees, and any other studio or dance related items purchased on account).
By checking below, you agree to take full responsibility for payment of all charges and understand that a $25 late fee may be applied to your account if your credit card/bank account is declined and cannot be processed for the amount due at that time, regardless of reason. Any balance left on your account as of the automatic draft processing time will be collected during the processing.
To discontinue enrollment in e-payment, you must fill out an "Account Removal Form" (found in the handbook or available in the front office) and return to the studio office. Tuition is due by the 1st of the month, no later than the 10th, and can be paid via cash, credit/debit card, or check.
The DanceLife Center accepts cash, check, VISA, MasterCard or Discover Card for an annual or Semester participation that is paid in full. For credit cards, a convenience fee of 3% will be charged.
Students and parents/guardians are responsible for making sure all medical conditions and allergies are fully described on the student's tab in the Parent Portal and kept up-to-date. This includes a description of any required emergency care medication or device (such as an "epi-pen," inhaler, etc.) which the student may need and specific instructions for when/under what circumstances the medication/device should be used, and how it should be used.
In addition, all students with an emergency medication/device must comply with the following requirements:
• The medication/device must be placed in a closed plastic baggie clearly labeled with the student's name and easy to understand written instructions concerning when/under what circumstances the medication/device should be used, and how it should be used. The instructions in the baggie also must include the name and telephone number for two emergency medical contacts.
• Students with a medication/device are required to bring the baggie to and from DanceLife activities and, at all times while at DanceLife, to keep the baggie in a gear bag on their person or, during classes, in the classroom.
By checking below, you acknowledge and understand that DanceLife does not render medical care, including medical diagnosis or treatment, to students or others, and that any assistance that DanceLife staff may offer to a student will be limited to responding to an emergency.
I hereby give permission for audio and visual images of me and/or my child under age 18, captured during regular DanceLife Center, LLC, D.B.A DanceLife activities/events/trips through, audio, photo and /or video recordings means, to be used solely for the promotional material, multimedia and publication purposes of DanceLife Center, LLC, D.B.A DanceLife and waive any rights of compensation or ownership thereto.
Note: For the safety of the youth NO FULL NAMES OF STUDENTS will be used in any Public forum, expressly concerning the internet.
By checking the box below, you specifically have read, understand, and agree to the following statements regarding each student you are registering (referenced below as "Student"):
1. I recognize that programs at The DanceLife Center, LLC ("DanceLife") require physical exertion that may be strenuous and involve inherent risks of serious physical injury (including death), and I am fully aware of the risks and hazards to Student presented by his/her participating in such programs. I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, EVEN IF ARISING FROM THE NEGLIGENCE OF THOSE PERSONS AND ENTITIES RELEASED FROM LIABILITY BELOW, AND I ACCEPT AND ASSUME FULL RESPONSIBILITY FOR ANY AND ALL INJURIES TO STUDENT THAT MAY ARISE AS A RESULT OF PARTICIPATING IN ANY DANCELIFE PROGRAM.
2. I understand that the activities involved in DANCELIFE programs are only suggested, and that not everything will be appropriate for everyone. I accept responsibility for assuring that my Student will: listen to his/her own body; be aware of any physical conditions in his/her body; and know that he/she is not obligated to perform the activities suggested by DANCELIFE personnel.
3. I understand that it is my responsibility to consult with a physician prior to Student's participation in any DANCELIFE program to determine the appropriateness of Student's participation. I represent and warrant that Student is physically fit and does not have any medical condition(s) that would prevent his/her full participation in DANCELIFE programs. I agree to immediately notify DANCELIFE of any pertinent changes in Student's health, including updating all medical information on the Customer Portal and keeping Student's instructor fully informed. If Student is out for an injury, I agree that Student will not return to participate in DANCELIFE activities until appropriately released by his/her physician to do so. I acknowledge that DANCELIFE has not and will not render any medical services to Student, including medical diagnosis or treatment of any physical condition.
4. I understand that DANCELIFE does not carry medical insurance for Student. I agree to maintain sufficient medical insurance and to pay all costs associated with any injuries that may occur as a result of Student's participation in DANCELIFE programs.
5. IN CONSIDERATION OF STUDENT BEING PERMITTED TO PARTICIPATE IN DANCELIFE PROGRAMS, I, ON BEHALF OF STUDENT, MYSELF, MY SPOUSE, AND OUR RESPECTIVE HEIRS AND ASSIGNS, HEREBY HOLD HARMLESS, WAIVE, AND RELEASE DANCELIFE AND ALL ITS OWNERS, OFFICERS, DIRECTORS, REPRESENTATIVES, EMPLOYEES, AGENTS, VENDORS, CONTRACTORS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, THE "RELEASEES") FROM AND AGAINST ANY AND ALL LIABILITY, CLAIMS, ACTIONS, AND CAUSES OF ACTION, WHETHER KNOWN OR UNKNOWN, WHETHER NOW EXISTING OR ACCRUING IN THE FUTURE, ON ACCOUNT OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE, OR OTHER LOSS ARISING OUT OF OR ATTRIBUTABLE IN ANY WAY TO STUDENT'S PARTICIPATION IN DANCELIFE PROGRAMS. THIS RELEASE SPECIFICALLY INCLUDES INJURY, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE NEGLIGENCE OF DANCELIFE AND/OR OTHER RELEASEE (S), BUT EXCLUDES INJURY, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE GROSS NEGLIGENCE OR WILLFULL OR WANTON MISCONDUCT OF DANCELIFE AND/OR OTHER RELEASEE (S). WE COVENANT THAT NEITHER I, NOR MY SPOUSE, NOR STUDENT WILL MAKE OR BRING ANY SUCH CLAIM AGAINST DANCELIFE OR ANY OTHER RELEASEE, AND WE FOREVER RELEASE AND DISCHARGE DANCELIFE AND ALL OTHER RELEASEES FROM LIABILITY UNDER SUCH CLAIMS.
6. In the event that Student is a minor: I warrant and agree that I am the parent or legal guardian of Student; that I have the legal right to consent to this Acknowledgement and Release on behalf of Student, myself, my spouse, and our heirs and assigns; that by signing below, we hereby do consent to the terms and conditions of this Acknowledgment and Release; and that my spouse and I understand and agree that the release of liability and claims set forth above includes any and all claims and causes of action that we may have, now and in the future, that are derivative of those of Student.
7. In the event that Student is not a minor: I warrant and agree that by signing below, I do hereby consent to the terms and conditions of this Acknowledgment and Release on my own behalf as the Student.