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 OUR PROVIDENCE ROAD OFFICE TO REGISTER IN-PERSON USING PAPER REGISTRATION.
This authorization concerns consent to communicate electronically in the submission of forms and documents related to enrollment and participation in Miller Street Dance Academy ("MSDA") 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.
Please review the consent below and indicate if you are willing to communicate electronically on these matters by providing your electronic signature below.
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 to Michelle Rogers or by U.S. mail addressed to Michelle Rogers at Miller Street Dance Academy, 11115 Golf Links Drive, Suite A, Charlotte, North Carolina 28277. Your withdrawal shall be effective upon notice of receipt from Ms. Rogers. 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 MSDA.
By checking the box below, you are: (1) consenting to communicate electronically with MSDA with regard to enrollment and participation in MSDA programs; (2) authorizing MSDA to send you notices, disclosures, and forms electronically, and agreeing that information and responses that you provide to MSDA 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.
By registering online, you are automatically signed up for e-payment and you are authorizing MSDA to use the account information for all of your account billing (including registration fee, tuition, costume 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.
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.
After the 10th of the month, a $25 late fee will be charged and enforced on all accounts past due, including e-payment accounts. Late notices will be sent via email. Tuition is not pro-rated for absences or studio closures. Students are encouraged to attend makeup classes for classes missed.
For more information on fees and tuition please visit the Tuition page of our website located under the Registration menu.
Please note, there are no registration fees for summer classes.
All students and parents are required to read the Student 2018-2019 MSDA Student Handbook prior to the first day of classes and to comply with all policies and requirements contained in the Student Handbook. Handbook is available by clicking this link: studio handbook
By checking below, you agree that you have been provided a copy of the 2018-2019 MSDA Student Handbook or have accessed a copy via the MSDA website. Further, you agree that you and your student have read the Student Handbook and understand that the failure of any student or parent/guardian of a student to comply with the Handbook or the provisions below may result in the student's immediate suspension or expulsion from MSDA activities.
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 MSDA activities and, at all times while at MSDA, to keep the baggie in a gear bag on their person or, during classes, in the classroom.
Notwithstanding the above, by checking below, you acknowledge and understand that MSDA does not render medical care, including medical diagnosis or treatment, to students or others, and that any assistance that MSDA staff may offer to a student will be limited to responding to an emergency.
MSDA uses photographs and videos of its own dancers in its marketing and promotional materials. However, MSDA will not include names of any dancers under the age of 18 beside a photograph or video unless specific permission from a parent/guardian has been obtained.
By checking the box below, you are granting MSDA full permission to take, use, reproduce, and publish photographic, video, and digital images of your student (collectively, "Images") for MSDA marketing and promotional purposes during and after the student's participation in MSDA programs. Further, by checking the box below, you acknowledge that MSDA shall be the exclusive owner of all rights, including copyright, in the Images, and you irrevocably transfer, assign, and otherwise convey to MSDA your entire right, title, and interest, if any, in and to the Images and all copyrights and other intellectual property rights in the Images.
IF YOU WISH TO OPT OUT:
If you do not wish to have photographs or videos of your student(s) used in marketing and promotional materials by MSDA or otherwise want this Photography and Video Release to not apply to your student(s), you must indicate that you are opting out in the appropriate online box. Specifically, new registrants must type "I OPT OUT" in the appropriate box on the Web Registration Form. Current families must log into their portal, go to the Account tab, click Settings, and edit (click the pencil) and type "I OPT OUT" under Additional Information in Family Details.
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 Miller Street Dance Academy, LLC ("MSDA") 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 MSDA PROGRAM.
2. I understand that the activities involved in MSDA programs are only suggested, and that not everything will be appropriate for everyone. I accept responsibility for assuring that 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 MSDA personnel.
3. I understand that it is my responsibility to consult with a physician prior to Student's participation in any MSDA 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 MSDA programs. I agree to immediately notify MSDA 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 MSDA activities until appropriately released by his/her physician to do so. I acknowledge that MSDA has not and will not render any medical services to Student, including medical diagnosis or treatment of any physical condition.
4. I understand that MSDA 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 MSDA programs.
5. IN CONSIDERATION OF STUDENT BEING PERMITTED TO PARTICIPATE IN MSDA PROGRAMS, I, ON BEHALF OF STUDENT, MYSELF, MY SPOUSE, AND OUR RESPECTIVE HEIRS AND ASSIGNS, HEREBY HOLD HARMLESS, WAIVE, AND RELEASE MSDA 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 MSDA PROGRAMS. THIS RELEASE SPECIFICALLY INCLUDES INJURY, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE NEGLIGENCE OF MSDA AND/OR OTHER RELEASEE(S), BUT EXCLUDES INJURY, PROPERTY DAMAGE, AND OTHER LOSS CAUSED BY THE GROSS NEGLIGENCE OR WILLFULL OR WANTON MISCONDUCT OF MSDA AND/OR OTHER RELEASEE(S). WE COVENANT THAT NEITHER I, NOR MY SPOUSE, NOR STUDENT WILL MAKE OR BRING ANY SUCH CLAIM AGAINST MSDA OR ANY OTHER RELEASEE, AND WE FOREVER RELEASE AND DISCHARGE MSDA 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.