FAMILY NAME *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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EMERGENCY CONTACT *

First Name

Last Name

Phone *

(###)

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DANCER #1 *

First Name

Last Name

DANCER #2

First Name

Last Name

DANCER #3

First Name

Last Name

DANCER #4

First Name

Last Name

Waiver of liability/photo & video *

I understand and agree that in participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury and, in rare circumstances, death. I agree to release and hold harmless Mirror Image Dance Company, including its teachers, dancers, staff members, and facilities from any cause of action, claims, or demands now and in the future. I will not hold Mirror Image Dance Company liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes. Furthermore, I understand that I should be aware of my, and/or my child's physical limitations and agree not to exceed them. If I am signing this waiver for my child, I certify that I am the parent or legal guardian and have the right to waive these rights. Further, I authorize and agree that Mirror Image Dance Company may take and use photographs/videos of me and/or my child for purposes of record keeping, advertising, and marketing. I understand that I do not have any rights to these photographs/videos and will not be compensated for the same.

I've read the above and agree.

Studio Policies *

TUITION POLICY. Tuition is due the first of the month. The estimate will be sent 7 days prior to the first via email. You must accept the estimate to pay by the first of the month. All accepted estimates will be charged on the first of the month. If tuition is received after the 5th of the month, there will be a 10% late fee. If tuition is not received by the 10th of the month, then the dancer cannot participate in classes. Tuition is based on four classes per month. Months with five classes are used to offset holidays and studio closures. Mirror Image Dance Company will accept: Cash, Checks, Money Order, Visa or Mastercard. Returned Checks: There will be a $25 NSF fee for all returned checks. After the 3rd returned check MIDC will require that all fees be paid by cash or card. Families must give a 30-day notice if you chose to take a break from MIDC. There will be no refunds for missed classes. MIDC operates on a invoice-system. All dancers should have a card registered with the business. No charges will be applied to the card unless estimates are accepted. Monthly Tuition: Tuition is billed automatically on the 1st of each month. If you registered in the middle of the month, your card will be charged on the 1st of the next month. Proration: The tuition will be prorated until your subscription becomes active. Change/Cancel Monthly Tuition: To cancel your membership, call us at (530) 400 - 5144 or contact us here. You can cancel your membership at any time, but it will be effective on the 1st of next month. MAKE-UP POLICY. Students may make-up missed classes within one month of absence. Please check in with the front desk before attending a make-up class. PRIVATE CLASSES - CANCELLATION POLICY. Private lessons must be canceled within 24 hours. If prior notification is given, rescheduling the appointment is possible. No-shows are not eligible for make-up sessions. DRESS CODE. MIDC requires studio uniform for all classes. This includes leotard, tights, dance shoes (ballet, pointe, etc). All outside footwear must be changed (to dance footwear) upon entering the studio. Street shoes are not permitted on the dance floor (with the exception of Hip-Hop classes). Hair must be in a clean bun, unless specified otherwise (hip-hop). ATTENDANCE, OBSERVATION, AND PICK-UP. MIDC operates on a drop-off and pick-up policy for students of ages 4-12. Students aged 2-5 can be observed by their parent(s) or guardian if necessary. If a parent needs to be in the room with their child, they should refrain from talking during the class. If you are late to pick up your child, we will wait until your arrival. However, after 30 minutes you will be charged $25 fee. MIDC assumes no responsibility for children on the premises before, after, or between their specified class times. Parents and guardians are responsible for arranging proper supervision of their children if it is necessary for them to stay in the building for periods of time before, after, or in between classes. Parents may want to consider making arrangements with older students or babysitters to ensure supervision of younger students. PRORATING - Students can enroll in a class at any time. The tuition will be prorated.

I've read the above and agree.

Authorization *

I am 18 years old or older and/or I am the legal guardian for the minors listed above.

I've read the above and agree.

*

First Name

Last Name