Dancer Name *

First Name

Last Name

Dancer Date of Birth *

MM

DD

YYYY

Parent/Guardian Name (Primary Contact)

First Name

Last Name

Parent/Guardian - Cell Phone

(###)

###

####

Secondary Emergency Contact - Name

First Name

Last Name

Secondary Emergency Contact - Phone

(###)

###

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1.0 RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT *

In consideration of participating in health or fitness club activities, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence The Ryan Academy of Irish Dance and its owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate and also agree as follows: 1. I acknowledge that health or fitness club activities involve known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, musculoskeletal injuries, broken bones, and/or overuse injuries, injuries caused by equipment that breaks or otherwise fails; death as a result of drowning or brain damage caused by near drowning; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity. 2. I expressly accept and assume all the risks inherent in this activity or that might have been caused by the negligence of Releasees. My participating in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that even conditions are unsafe or that I am unable to participate due to physical or mental conditions, then I will immediately discontinue participation. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to Indemnify and hold them harmless for all such fees and costs. 4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume –and bear the costs of –all risks that may be created, directly or indirectly, by any such condition. 5. In the event that I file a lawsuit, I agree to do so solely in the state where Releasees’ facility is located and I further agree that the substantive law of that state shall apply. 6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I agree that if I am hurt or my property is damaged during my participating in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.

I have read, understood and agree to the policies and conditions outlined above on behalf of myself/my child.

2.0 CONSENT FOR TREATMENT FOR ACCIDENT & ILLNESS (Participants under 18 only)

Hospitals require that parents or adult guardians must give written consent before treatment of a minor (person under the age of 18) may begin unless the situation is life threatening. I understand that the Ryan Academy is not responsible in matters of illness or accidents. I certify that my child has had a medical examination to assure the physical fitness and capability to perform the dance involved in the program offered by the Ryan Academy. In the event of an emergency, I hereby give permission to the licensed physician selected by the Ryan Academy to hospitalize, secure proper treatment, anesthesia, or surgery for my child.

I have read, understood and agree to the policies and conditions outlined above on behalf of myself/my child.

Not Applicable

3.0 PHOTO/VIDEO CONSENT *

During the dance year, pictures and/or videos are taken of Ryan Academy dancers for in-house use and for educational or marketing purposes. These pictures or videos may be used in combination with Ryan Academy brochures, website or appear in community publications.

I give permission for the above described to be used by the Ryan Academy of Irish Dance.

I do not give permission for the above described to be used by the Ryan Academy of Irish Dance.

Date

MM

DD

YYYY

Student Agreement *

By agreeing to this section I acknowledge that I have received and reviewed a copy of the Ryan Academy Student/Parent Handbook and agree to the full policies and details it contains, including but not limited to: TUITION PAYMENT SCHEDULE The annual registration fee is payable at the beginning of the first class. Monthly tuition is to be paid at the first class of each month. Some months will have three classes and other months five classes. Tuition does not change with these monthly variations. PAYMENT METHODS Tuition is payable via eCheck or CC (3% fee) invoice to the Ryan Academy of Irish Dance. Payments received more than 7 days after invoice date may l be assessed a $10.00 late fee. CANCELLATIONS AND MAKEUPS POLICY Classes cancelled for weather or other circumstances will be covered either by make-up lessons or adjusted tuition for the next month at the discretion of The Ryan Academy. A class with an enrollment of less than 5 may be subject to cancellation. In case of cancellation all payments will be fully refunded. Parents/guardians are responsible for lesson fees, whether or not the dancer attends class. Credit is not given for missed classes. Classes missed due to illness, family emergency, or other approved circumstances may be made up within the same month as the absence by attending a different class with instructor approval. Classes missed due to vacations or scheduling conflicts with other activities are the responsibility of the parent/guardian and not covered under the makeup policy. Please note that make-up classes are not a 1 to 1 substitute for missing your regular class. Private lessons are available to cover missed material at the published rates. Monthly tuition will not be prorated for any reason outside of the above stated circumstances. REFUNDS FOR WITHDRAWAL 100% refund if notified before the first class of the month. 50% refund if notified after the first class of the month. Monthly tuition will not be refunded after the second class of the month.

I have read, understood and agree to the policies outlined above.