MISS CAROL'S SCHOOL OF DANCE
REGISTRATION FORM AND MEDICAL AND REFUND POLICY AGREEMENT
Please print out this page, fill in the appropriate fields, sign at the bottom
and mail
with your payment to:
Miss Carol's School of Dance, 502 Metlars Lane, Piscataway, NJ 08854
Student's Name:__________________________ Age:______ Birthdate:___________
Grade in School:_________
Parent(s) Name(s):________________________ Telephone Number:_____________
Work Number:___________________Cell Number:__________________________
Address:____________________________________________________________
Email Address:_______________________________________________________
How would you prefer to receive your Newsletters?_________paper__________email
Name of class(es) requested, day and time:
__________________________________________________________________
(please check age requirements before choosing classes)
PHOTO AND VIDEO AGREEMENT
I understand that any photos or videos taken of me or my child can be used by Miss Carol's School of
Dance for promotional
purposes and that I or my child will not be compensated for their use.
Names are not used.
MEDICAL INFORMATION
I understand that Miss Carol's School of Dance will not be held responsible
for any bodily injuries sustained while
on the premises, or for loss or damages to any personal items brought on the
premises by students or their families
and friends. In the event of an emergency, I hereby give authority to Miss Carol's
School of Dance to obtain necessary
emergency medical treatment for my child in the event of my absence, with the
understanding that the family will be
notified as soon as possible. The family is responsible for any and all charges
corresponding to such treatment.
REFUND & WITHDRAWAL POLICY
In the event of a prolonged illness or injury that requires extended hospital
care, a prorated refund will be made
(up to, but not exceeding, 50% of tuition paid during illness) provided that
written medical verification is presented
to Mary Eckert within 30 days of the illness or injury. There will be no refunds made for voluntary withdrawal, missed
or
canceled classes, sports seasons,
holidays, vacations, inclement weather or lack of interest. There are no refunds for
costumes, tickets, ads, dancewear,
or any other items for sale at Miss Carol's School of Dance.
I have read the Brochure, Student Handbook, and Medical and Refund Policy and
understand and agree
to all of the regulations, rules and requirements of Miss Carol's School of
Dance.
______________________________________________________________________________________
Parent Signature (Required for Registration) and Date