English as a Second Language Registration Form 2023-2024
East-West Cultural and Educational Center (EWCEC) 3655B Old Court Rd Suite#20 Pikesville MD 21208

Phone: 410-205-6002 / E-mail: admin@eastwestschool.org   
Ukr: Будь ласка, дайте знати, якщо Вам потрібна допомога у заповненні цієї форми.
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Email *
First & Last Name *
Phone Number *
Home Address *
Date of Birth *
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Preferred Spoken Language *
Please select a class of your choice. Tuition is $100/person for 10 classes. *
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I understand that students are responsible for paying a 10-class session Tuition and a NEW STUDENT registration fee of $50/ person. If 10-class sessions are taken continuously, the registration fee is waived for subsequent sessions ($0).  If there is a break between 10-week sessions, the RETURNING STUDENT registration fee of $30/ person is charged.                                                                                                                                                                                         

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I have further received and reviewed the East-West Cultural and Educational Center (EWCEC) rules and policies. I agree to abide by all EWCEC’s policies and the tuition payment schedule as described below:
 
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I understand that EWCEC does not give credit and/or refunds for class(es) missed due to holiday, vacation, illness, weather, etc. I further understand that there are specific risks of physical or property damages, losses, or injury that may result from participation with EWCEC classes, and I voluntarily assume the risks associated with such participation.

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I understand that all fees are non-refundable and non-transferable, not eligible for credit, and may not be used for classes that are not included in the tuition during the school year (example: summer classes). Missed classes are non-refundable and may not be transferred to another student or made up after withdrawal from the program.         

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I understand that make-up classes are not available. Missed classes may not be deducted from tuition payments.                                                                                                                                   

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I understand that EWCEC reserves the right to use photography and video of classes and performances for promotional purposes and marketing.        

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Your level of English *
Please list the student's medical conditions: including allergies, asthma, ADHD, ADD, diabetes, epilepsy, etc. or any previous injuries that may affect class participation. If none, please indicate NA *

I certify that I am in good health and that I do not pose a health risk to the public. 

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I understand that the instructor is entitled to up to One sick day per 10-class session, and EWCEC will try its best to assign a substitute teacher. I understand that there is no reimbursement or make-up of a class cancelled due to the instructor’s sickness. *

I waive and release EWCEC, its staff, and independent contractors from any and all liability for any injuries or illnesses incurred while engaged in travel to or from and while at EWCEC.       

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I HEREBY recognize and ASSUME ALL OF THE RISKS OF PARTICIPATING IN EWCEC's activities, classes, rehearsal and or performances, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

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In the event that a special medical/health problem, need, restriction, and condition arises, I will notify EWCEC immediately.  If such an event occurs, I acknowledge that I must obtain written permission from a certified physician prior to resuming any and all EWCEC activities, classes, events and or performances 

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I understand that EWCEC is not responsible for any loss  resulting from any property damage or personal injury arising out of or connected with the use of the facilities or participation in the classes or program. Additionally, I understand that EWCEC is not responsible for any personal belongings left in the studio. All lost and found items are donated to charities at various times throughout the year.                   


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You are almost there...  💕 😇   

I HEREBY WAIVE, RELEASE, AND DISCHARGE EWCEC, its successors and or assigns, employees, partners, officers, directors, teachers, guests, volunteers, or the activity or event holders, activity or event sponsors, activity or event volunteers of any and all liability and responsibility for injuries, sickness, pandemics, accidents, natural disasters and/or acts of God incurred during participation in and/or instruction of camps, private lessons, or any activity I may participate.  

I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: EWCEC, its successors and or assigns, employees, partners, officers, directors, teachers, guests, volunteers, or the activity or event holders, activity or event sponsors, activity or event volunteers.

 I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this waiver, release and registration form from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.      

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PARENT / GUARDIAN WAIVER FOR MINORS (Only if a student is less than 18 years old)

The undersigned parent and/ or legal guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in EWCEC activities, classes, rehearsals, performances and/or events, and has agreed individually and on behalf of the child or ward, to the terms of the waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor, the parents, of the legal guardian.

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. 

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COVID Disclosure and Waiver

I acknowledge the contagious nature of COVID-19 and other contagious diseases and viruses and voluntary assume the risk that I and/or my children may be exposed to or infected by COVID-19 by attending and participating and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 and other contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, independent contractors, volunteers, and program participants and their families. I release EWCEC, its instructors, independent contractors and all associates from liability for harm, injury or death pertaining to COVID-19 and other contagious diseases and viruses.

I understand that all staff and students are required to contact studio directors should they feel ill, test positive for COVID-19 or be in contact with someone who tests positive for COVID-19. 

I agree to keep my student at home if they are not feeling well, or if they or anyone in the household are exhibiting any of the COVID-19 symptoms listed below:

·    Fever (100.4°F or greater)

·    New/Worsened cough

·    new/worsened shortness of breath

·    Sudden loss of taste/smell

·    Nausea/Vomiting/Diarrhea

·    Runny nose or congestion

·    Myalgias (unexplained muscle aches/soreness)

·    Fatigue

·    Chills

·    Sore throat

·    Headache

 

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How did you hear about our ESL classes? *
What other classes would you be interested in taking in the future? *

I understand that this release form must be signed before attending class.              

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All the information presented here is true to the best of my knowledge.  I have read and understand all of the EWCEC Center Policies. 

Signature (Write your Full Legal Name)
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