Elite Membership
Please print and return to The Dance Family Studio front desk for processing

 

Benefits:   * Elite Metal Badge

                * Monthly $10 discount

                * No monthly registration

                * Elite Member Discounts

Agreement & Studio Policies

Assumption of Risk  
In consideration of participating at the The Dance Family Studio I represent I understand the nature of this activity and that the student is qualified, in good health, and in proper physical condition to participate in such activity. And I understand the nature of the above referenced activities and my experience and capabilities and believe I am qualified to participate in such activity. I acknowledge that if I believe event conditions to be unsafe, I will immediately discontinue participation in the activity. I fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "releasees" named above; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in the activity. I understand that all dance students should be covered by their own insurance policies, and if injury occurs, I understand that my own policy is the only source of reimbursement.  I hereby acknowledge that I am choosing to participate at my own risk.
I've read the above and agree.  

Payment Information Payment will be attempted twice. If payment is unsuccessful on the first day of the month, a second attempt will be made on the third day of the month.  Thirty (30) days written notice is required for cancellation of monthly charges. This is an annual membership, but charged monthly.  With this annual membership, there are benefits including but not limited to discounts. Memberships may be put on temporary hold for up to two months per year due to traveling, illness, etc.  After one full year, the contract reverts to a month-to-month in which the memberships can be put on temporary hold for up to two months per calendar year. Pre-mature withdrawal (prior to one year) from the program will result in full charge of all previous months (up to maximum of $10 per prior month), and there are no refunds. 
I've read the above and agree.  

Studio Policies to maintain the community environment of our Dance Family, and for your comfort while you are with us, we reserve the right to refuse service.  In addition, and we support a “no fraternizing with students” policy for our entire staff. 
I've read the above and agree.  

Digital images may occasionally be taken of class participants. The Dance Family Studio or Francisco and Stacey Martinez or their staff uses these images in marketing media. Please inform our office if you do not wish to allow these images to be used without compensation to you.
I've read the above and agree.  

Please call Jan’s studio phone (626) 255-2136 when wanting to put the membership on temporary hold. We request 30 days notice, but exceptions can be made if notified up until the week prior to the month wanting to temporary hold membership.    

Signature _____________________________

Month to start _______________   Year 20___

Name for Elite Badge ____________________

  
     Street Address _________________________

        City ______________________  Zip _______

Phone _______________________________

Email ________________________________

office use only          ______/______/______/______            __/__