Registration

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This is a secure website. Fill out the information and pay below. This form must be signed by the student's PARENT (if student is under age 18). Welcome to Faberge Follies!

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Referral Information
Family Information
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Additional Info
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Contact #2
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Student #1
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Additional Info

Please select the class you want to take. If unsure contact Miss Faberge 570-454-1418. She'll help you choose. When you come to your first class, you'll be evaluated to be sure you've made the ideal selection. Miss Faberge must approve of your placement. ----- Or, if you don't want to select a class right now, just skip to the next step.

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Required Policies and Agreements
I, the undersigned, on behalf of myself or a minor listed above, do hereby request enrollment in the Dance, Acrobatics/Gymnastics, and related Activities classes conducted by Faberge Follies. In consideration thereof I, for the minor and/or myself, our executors and assigns and other representatives do hereby release and hold harmless Faberge Follies and its owners from any and all claims, causes of action or suits which may result from the enrollment in these classes or any of the school's related functions, except for gross negligence on the part of Faberge Follies, while in or upon the premises or any premises under the control and supervision of Faberge Follies, its owners and staff or in route to or from any of said premises.

I am aware that Dance, Acrobatics/Gymnastics and related Activities training places unusual stress on the body and carries with it the risk of physical injury. Students may suffer injuries, possibly minor, serious, or catastrophic in nature.

I will make my child aware of the possibility of injury and encourage my child to follow all safety rules and coaches' instructions. I understand that it is the parent's responsibility to warn the child about the dangers of Dance, Acrobatics/Gymnastics and related Activities in language that the child understands. Faberge Follies will only warn the child through Safety Messages and our teaching style and progressions.

In the event of illness or injury, or if deemed necessary by the Faberge Follies staff, I hereby give my consent to Faberge Follies staff, volunteer or paid, to provide, through a medical staff of its choice, customary medical/athletic training attention, temporary first aid, transportation, and emergency medical services as warranted in the course of the minor's participation. I certify that I personally and/or my medical insurance carrier will be responsible for all expenses which are incurred in relation to any injury sustained during any Faberge Follies activity including but not limited to class, competition, performance, etc.

I affirm that I now have and will continue to provide continuous, proper hospitalization, health, and accident insurance coverage which I consider adequate for both my child's protection and my own protection. I understand that if injury does occur, the student's own policy is your only source of reimbursement.

I understand that good Dance, Acrobatic/Gymnastics, and related Activities training involves touching and adjustment of the student's body by the instructor to help the student feel proper placement of the head, neck, torso, arms, hands, legs, and feet and to assist in the safe execution of and learning of skills.

GRANT: For consideration which I acknowledge, I irrevocably grant to Faberge Follies ("Company") and Company's assigns, licensees, and successors the right to use my image and name in all forms and media including composite or modified representations for all purposes, including advertising, trade or any commercial purpose throughout the world and in perpetuity. I waive the right to inspect or approve versions of my image used for publication or the written copy that may be used in connection with the images.

RELEASE: I release Company and Company's assigns, licensees, and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. Company is permitted, although not obligated, to include my name as a credit in connection with the image.

Company is not obligated to utilize any of the rights granted in this agreement.

I have read and understood this agreement and I am over the age of 18. If signing for a minor I affirm that I am the parent and legal guardian of said minor named above. I have legal right to consent to and do consent to the terms and conditions of this image (model) release.

This agreement expresses the complete understanding of the parties.

I understand that Faberge Follies may assign a substitute teacher of it's choice, person & subject matter, when it deems necessary.

Classes missed due to weather, illness, holiday or any other reason can be make-up within one month or forfeited. No credit will be given.
When Hazleton Area School District cancels, due to weather, we cancel, too.

Tuition: There are 2 options: 1) Put your credit card on file with us and we'll automatically charge it every month for tuition due. It's your obligation to inform the office via email, fabfol@me.com, if you no longer authorize your credit card to be charged.; or... 2) If you prefer to pay by check, cash, or credit card one time (instead of credit card on file) you have the option to pay twice yearly in advance for your lessons (September 1 and February 1).

Concerning Costumes for the big Celebration show in June: There will be 3 equal costume installments ($50 each, for total payment of $150) posted to your account for each number your child is performing in for Celebration. ($50 each on November 1, February 1, and May 1.)

I agree to allow FAberge Follies to charge my credit card on the first of each month, for any balance due. If I no longer take lessons, I understand it's my responsibility to email the studio and ask that my card be deleted.

I Agree to All of the Above
Questions or Concerns
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