Student Registration form

Student Information

example 31.12.2006

Parent(s)/Guardian(s) residing with child

All persons authorized to pick up child

Authorization and Waiver to Transport Child

Authorization Is Valid: August 15, 2018 to July 15, 2019


I authorize Natalie Dance Show, Inc. to transport my minor child in a company Bus, Van or car, driven by an individual authorized by Natalie Dance show, Inc. I understand my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or staff or volunteer. I understand participation in the identified event is not a requirement for participation in the program.

I have read, understand, and discussed with my child:

(1) My child will travel in a motor vehicle driven by an adult and my child is to wear their safety belt during travel;

(2) My child is expected to listen to supervising staff/driver, respect staff and other children, the vehicles they ride in, and the people they travel with during the trip;

(3) Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; and,

(4) My child is to remain in their seat and not be disruptive to the driver of the vehicle.

Initial Each Statement

I recognize participation in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss. I hereby attest and verify I have been advised of the potential risks, and I have full knowledge of the risks involved in this activity, and I assume any expenses incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses.

As a condition for the transportation received, I, for myself, my child, my executors and assigns, further agree to release and forever discharge Natalie Dance Show, Inc., and their agents, officers, employees and volunteers from any claim that I might have myself or that I could bring on my child’s behalf with regard to any damages, demands or actions whatsoever, including those based on negligence, in any manner arising out of this transportation.

I have read this entire waiver and authorization form, I fully understand its terms and conditions, and I agree to be legally bound by its terms.

Payment and policies information

Payment Plans: (Circle one of the plan choices and initial)

Plan A: Automatic credit card payment on the first of each month. (A 30 days notice from the first of the month is required to discontinue classes. All automatic bank debits will stop after the one-month notice period.)

Plan B: Check or cash must be paid till 5th of the each month. Late fee $15 will be charged after 5th of each month.

Plan C: Credit card (3% bank transaction) must be paid till 5th of the each month. Late fee $15 will be charged after 5th of each month

Registration fee:

The registration fee is $ 50 per student. All new and returning Natalie Dance Academy students are required to pay a registration fee at the start of each new dance year if did not attend classes for 2 and more months.

Performance costumes and dry cleaning fee:

100$ annually (Will be charged from first performance of the child) $ 5 for each costume for each performance per child for dry cleaning/cleaning/repair (no discounts) For 5 and more costumes for 1(one) performance, dance competitions or tours will be calculated differently

Uniform must be worn in each class, NO EXCEPTIONS, a child who does not have on the required uniform will be asked to sit and observe the class. Uniform fee for practice and dance shoes are not included will be charge separately.

First class for new student is free. Single class is $25 for 40 min or one hour class, $30 for one and half hour class.

Monthly tuition:

Tuition must be paid by automatic bank account debit or till 5th of the each month. Tuition and registration fees under no circumstances will be refunded or prorated. The monthly tuition is based on the entire dance year: all Holidays, studio closures, and competitions are tallied into the payment. There is no prorating monthly tuition due to illness, school, or vacation. Students are permitted to makeup classes missed due to illness only within one month.

Dance/singing/acting class 1 time a week for 45 min or 1 hour-$90

Dance class 1 time a week for 1 and half hour- $100

Dance classes 2 times a week for 45 min- $155 (Age 3-6 years)

Dance/singing/acting classes 2 times a week for 1 hour-$165 (Age 5-9 years)

Dance classes 2 times a week for 1 and half hours- $185 (Age 9 and up years)

Dance classes 3 times a week for 1 hour- $215 (Age 5-9 years)

Dance classes 3 times a week for 1 and half hours- $255 (Age 9 and up years)

Unlimited classes (Suitable for the age category of the child) $395

-Dance classes 5/6 times a week

-Singing classes 2 times a week

-Acting classes 2 times a week


Team students 3-4 times a week $250 (permitted by director of the studio)

After care monthly fee:

-Pick up from schools

-Homework assistance

-Parents/guardian pick up from the studio at 7 the latest

1 time a week - 80$

2 times a week - 100$

3 times a week - 120$

4/5 times a week - 150$

Before or after classes care:

Natalie Dance Academy is not responsible for young unattended students and any siblings. Parents cannot leave young students unattended in Natalie Dance Academy studio before or after class unless after care paid as well as any siblings of the student.

No Student should be in the classroom unless enrolled in that particular class.

$5 per hour. (Available any time after school till 7pm)


-Siblings 10%

-For 3 months payment 5%

-For 6 months payment 10%


$35.00 service charge will be added for all returned checks or declined card

I understand that all fees paid are nonrefundable and nontransferable

It is the parents/guardians responsibility to be aware of all classes, rehearsals, performances, competitions, important events, and studio closures. All this information is posted in the front lobby and will also posted to Wats up App. (Read it carefully!!!)

Students should arrive on time, ready and dressed for class, if a child is 15 minutes late or more the child will be permitted to the class but will be asked to sit and observe. Please allow for appropriate restroom use prior to class, students are encouraged not to leave the room once a class has begun. No food or drinks except water is permitted in the classrooms. Chewing gum is prohibited in any of the classrooms. All students must practice respect for their peers and for the staff and teachers of Natalie Dance Academy. Please honor your teacher and fellow students by giving full attention and co-operation. Theft is NOT TOLERATED, any student taking property that does not belong to them will be asked to withdraw from the school. Dance class is education and fun, however, an important part of class work is developing an attitude of discipline and respect for teachers, fellow dancers, and the art of dance. We trust that following our procedures and etiquette will provide an environment whereby the art of dance can flourish and each dancer will attain their maximum potential. I have read and fully understood all the above-mentioned and agree to adhere to all procedures and rules of Dance Town. NATALIE DANCE ACADEMY’S CLASS DRESS CODE ALL STUDENTS MUST FOLLOW THE DRESS CODE REQUIREMENTS BELOW OR THEY WILL NOT BE PERMITTED INTO CLASS. THESE RULES WILL BE STRICTLY ENFORCED BY ALL NATALIE DANCE ACADEMY TEACHERS AND STAFF. NO IMPROPER HAIR, GUM CHEWING, OR JEWELRY WILL BE TOLERATED IN ANY CLASS! Girls: NDA blue leotard, beige shoes, hair must be tightly secured in a neat bun, no jewelry allowed. Boys: Black fitted dance pants, NDA blue tee shirt, black jazz shoes.




Indicated in the space above are any health problems or conditions of which the studio should be aware (such as heart, back, medical, allergy, muscular, pregnancy, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, hereby waive and release Natalie Dance Show Inc. and Natalie Dance Show Inc. officers and staff from any and all claims or damages of any kind arising out of my child’s participation in the exercise and/or dance program of Natalie Dance Show, Inc. I further certify that the aforementioned student is in proper physical condition to participate in the exercise/dance program and that he/she has been examined by a licensed physician and found to be in proper physical condition to participate in said program. I, the undersigned, do hereby authorize Natalie Dance Show Inc. or her designated agents (being teachers or administrators employed by Natalie Dance Show Inc.) to obtain medical treatment for my child in emergency situations where I cannot be reached I authorize the treating physician to provide such emergency medical services as he or she deems necessary. I understand that I am responsible for any and all medical expenses incurred and that the absence of health insurance does not make Natalie Dance Show Inc. responsible for payment of said medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect for one year from the date signed below.



In consideration of Natalie Dance Show inc. accepting my child into participation and training in dance and any other activities, which activity

I parent/guardian of child hereby acknowledge involves a greater than normal risk of injury, I agree as my child’s parent or guardian to assume all risks, cost, or losses sustained by me, my child, or my child’s family in connection with participation in dance classes, programs, lessons or meets. As a participant in any program, performance,classes, rehearsals or any activity of Natalie Dance Show Inc., I recognize and acknowledge there are risks to my child of multiple types of personal injuries. I agree to assume the full risk of any injuries, including death, personal injury of any nature, and any other damages or loss that my minor child may sustain as a result of participating in any activity, including without limitation, classes, performances, rehearsals etc., I understand that this release includes the release of any claim for personal injury of any nature, to my child, and any derivative claim that I may have, which is caused solely or in part by the negligence, action or inaction of Natalie Dance Show Inc., any of its officers and instructors, employees independent contractors, agents and other students. I herby agree to release, waive and relinquish all claims, including but not limited to any claims for negligence my minor child may have, arising from or as a result of participating in any program, performance, class, rehearsal, or any other activity without limitation, against Natalie Dance Show Inc., and its officers, agents, servants, employees and independent contractors. I further agree to indemnify and hold harmless and defend Natalie Dance Show Inc., its officers, agents, servants, employees and independent contractors from any claims resulting from injuries including death, damages and losses sustained by me or my minor child that arise out of, in connection with, or in any way associated with the activities of this program, including but not limited to claims for negligence, negligently caused personal injury caused solely or in part by Natalie Dance Show Inc., it's officers, instructors, employees, agents and independent contractors.


I give permission to Natalie Dance Show Inc. and/or appropriate medical facility to make whatever emergency first aid, disaster evacuation, etc. measures as judged necessary for the care and protection of my child while under the supervision of Natalie Dance Show inc. In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resources (police, rescue squad) deem it necessary. The child will be transported at my expense. I understand that in some situations, the staff will need to contact the local emergency resource before the parent, child’s physician, and/or other adult acting on the parent’s behalf.


Please sign this waiver if you will permit use of your child’s photographic and or video image as described below. If you do not sign this waiver, we will not use your child’s image as described. I understand that “Natalie Dance Show inc” dance school is an organization that promotes dance as an art form not only to its students, but also to the community at large. As such, social media, newspaper and magazine articles or advertising, brochures, videos and websites containing your child's image may be used either promotionally or educationally and may include images of Natalie Dance Show’s students or other participants in our programs. I hereby permit the use of my daughter/son’s image to be photographed, videotaped or otherwise recorded for use in Natalie Dance Show’s publicity, promotions or educational materials. These materials include, but are not limited to, photographs of classes, individual photographs of students and performances, the “Natalie Dance Show” newsletters, social media promotions on FaceBook, magazine and newspaper articles or advertising, various other school publications, and the Natalie Dance Show’s internet webpages.


All information will remain confidential. I hereby authorize Natalie Dance Show Inc. to initiate entries to my credit card account, and, if necessary, initiate adjustments for any transactions credited in error. This authority will remain in effect until I notify Natalie Dance Show inc. in writing to cancel it. Without written termination, there will be no reimbursements. Im agree to make transaction needed by Natalie dance show, inc. in case of payment due to avoid late payment fee

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