Registration

Registration is required before a student can attends class.

Hill Dance Academy Theatre
Registration Form

Student Information

Student's First Name

Student's Last Name

Birthday

Student's Email Address

Student's Phone Number

Student's Address

Student's Age

How does the student Identify

What school does your student attend

What grade is your student in

Additional Information

Parent | Guardian 1 Information

First Name

Last Name

Relationship to Student

Email Address

Celluar Phone Number

Work Phone Number

Street Address

Street Address Line 2

City

Postal / Zip code

First Name

Last Name

Relationship to Student

Email Address

Celluar Phone Number

Work Phone Number

Street Address

Street Address Line 2

City

Postal / Zip code

Emergency Contact
(Must not be a parent or guardian listed above)

First Name

Last Name

Relationship to Student

Email Address

Celluar Phone Number

Work Phone Number

Street Address

Street Address Line 2

City

Postal / Zip code

Media Release

Hill Dance Academy Theatre takes photographs and videos of participants enrolled in academy classes, participants taking master classes, and participants attending events and performances while in our facility. The photographs and videos taken are all for Hill Dance Academy Theatre promotion, publications, flyers, publicity, brochures, website use, other electronic communications, or video usage. All photographs and videos are for Hill Dance Academy Theatre’s use and become the sole property of Hill Dance Academy Theatre. Please contact the Executive Director, for any exclusions.

Media Release

I have read the above and give permission

I have read the above and do not give permission

Release of Liability

I, on behalf of myself and Student, and for Student’s, executors, and administrators, do hereby exempt, release, and forever discharge and not sue, Hill Dance Academy Theatre (HDAT) and its directors, officers, agents, employees, and instructors, hereby waive any and all claims which may occur from any cause whatsoever during or arising from Student’s participation at Hill Dance Academy Theatre (HDAT) including any injury to Student or Student’s guests or damage to Student’s property or Student’s guests’ property. HDAT shall not be responsible for and specifically disclaims any liability to Student for any loss, theft, injury, or liability incurred at HDAT.

Personal Liability Waiver

I have read the above and give permission

I have read the above and do not give permission

I understand some of the activities engaged in at the Academy are physically strenuous and only students who are medically able to participate should do so. Regardless of the cause, the student (or parents or guardian) assumes full responsibility for all risks of accident and personal injury that may result from participation in Academy activities. The Academy assumes no responsibility or liability with respect to the student's injuries which are sustained as the result of deficiencies in the student's physical health. Hill Dance Academy Theatre Faculty and Staff reserves the right to dismiss or otherwise discipline any person whose behavior is not acceptable or endangers the safety of themselves or others. Unacceptable behavior includes verbal harassment, physical assault or sexual abuse, and the use or possession of alcohol. The use, purchase or sale of any illegal substances at the Academy is strictly forbidden and will not be tolerated. If anyone is involved in any activity associated with these substances or devices, the appropriate law enforcement agency will be contacted to deal with the situation. No refunds will be made in the event of such disciplinary action. Costs incurred by the Hill Dance Academy Theatre in a disciplinary action will be the responsibility of the participant, Parent or Guardian.

Payment Refund Waiver

I have read the above and give permission

I have read the above and do not give permission

COVID-19 Liability Waiver (Please check all)

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that Hill Dance Academy Theatre has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Hill Dance Academy Theatre can not guarantee that I will not become infected with the Coronavirus/COVID-19.

I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions.

I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

I am following all CDC-recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

I hereby release and agree to hold Hill Dance Academy Theatre harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the dance academy, or that may otherwise arise in any way in connection with any services received from Hill Dance Academy Theatre. I understand that this release discharges Hill Dance Academy Theatre from any liability or claim that I, my heirs, or any personal representatives may have against the dance academy with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Hill Dance Academy Theatre. This liability waiver and release extends to the dance academy together with all owners, partners, and employees.

Hold Harmless Waiver

I understand and agree

Payment and Tuition Plans
(The following section outlines Hill Dance Academy Theatre's automatic payment system and payment structure)

Financial Regulations (please check each box after you have read the form to show that you understand)

In order for my child to be enrolled I MUST go to the Hill Dance Academy Theatre's website and subscribe to a monthly plan in accordance to my student's level.

Students who are delinquent in paying their tuition will not be allowed to take part in any classes and extra activities until their balances are brought up to date. Students with outstanding balances will not be permitted to register.

Accounts that are not paid per the agreement will be turned over to Hill Dance Academy Theatre's Board of Directors Finance Committee for collection.

Withdrawal and Dismissal (please check each box after you have read the form to show that you understand and agree)

For a student to withdraw from the program the Withdrawal Form must be completed. If the account is not up to date upon withdrawal the bill payer is responsible for any outstanding balance. At the end of the term, all unpaid balances are sent to a collection agency.

If a student decides to withdraw from classes Hill Dance Academy Theatre will cancel automatic payments upon receiving the withdrawal form. All payments withdrawn from your account before the student's withdrawal date are nonrefundable.

If a student is expelled from classes Hill Dance Academy Theatre will cancel automatic payments. All payments withdrawn from your account before the student's expulsion date are nonrefundable.

In case of injury, you are still responsible for payments.

The Parent/Guardian is required to notify Hill Dance Academy staff of the student's injury with a doctor's notice or complete a withdrawal form to withdraw the student from classes.

All payment disputes must be submitted in writing to the Hill Dance Academy Theatre administration office.

Parent Consent
Please Read Carefully

Consent

I agree that all sections outlined in this form are filled in correctly

Agreement

I have read, understand, and agree that by completing this form, it becomes my legally binding agreement with Hill Dance Academy Theatre.

Thanks for registering to our event. See you there!

Registration

Hill Dance Academy Theatre Registration Form

Student Information

Parent | Guardian 1 Information

Emergency Contact (Must not be a parent or guardian listed above)

Media Release

Release of Liability

Payment and Tuition Plans (The following section outlines Hill Dance Academy Theatre's automatic payment system and payment structure)

Parent Consent Please Read Carefully

Parent | Guardian 2 Information (If information is not available, leave this section blank)

Hill Dance Academy Theatre
Registration Form

Emergency Contact
(Must not be a parent or guardian listed above)

Payment and Tuition Plans
(The following section outlines Hill Dance Academy Theatre's automatic payment system and payment structure)

Parent Consent
Please Read Carefully

Parent | Guardian 2 Information
(If information is not available, leave this section blank)