2022/2023 Student Agreement
Complete the form below BEFORE September 5, 2022
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Email *
Full Name of Student
Name of Parent(s) or Guardian(s)
Student's Date of Birth mm/dd/yyyy
Mailing Address
Home Phone Number
Cell Phone Number
Emergency Contact Name & relationship to student
Emergency Contact Phone Number
Please list any allergies or history that will help us meet the needs of your child:
I/ We fully understand and acknowledge that: (a) there are risks and dangers associated in movement events and activities which could result in bodily injury (b) These risks and dangers may be caused by the action or negligence of the participant or the action, inaction or others included, but not limited to the release named below.  I/ We release, waive, discharge and covenant not to sue to Rising Stars Studio of Dance or any parties in association with Rising Stars, including owners, teaching artists and any other lessees of premises ( which will be referred to as RELEASE) used to conduct the Rising Stars programs
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I understand that tuition is due by the 1st of each month and is NON REFUNDABLE. A service fee of $25 will be added to any account with a bounced check. A $15 late fee will be applied to any payments received after the 10th of each month. I understand my child may be refused admittance into class if tuition has not been received. The dance season is based on approximately 26 dance classes and is broken up into 9 EQUAL monthly payments regardless if a class meets 4 or 3 times that month. NO REFUNDS OR CREDITS ARE GIVEN FOR MISSED CLASSES UNLESS RISING STARS CANCELS ( this excludes dates and holidays on the studio calendar)
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Rising Stars is not responsible for lost or misplaced items. All items brought to Rising Stars or related dance events should be labeled and kept in your child's dance bag/cubby
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I acknowledge that Rising Stars maintains a dress code for its classes. I understand it is my responsibility to provide the required items for class(es)
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In the event that neither the parent/guardian or emergency contact can not be reached, I hereby authorize Rising Stars and its staff to take any steps deemed necessary to take medical attention available, including physicians, hospitals or any other medical services and shall bear all costs of such services exclusively myself
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Rising Stars reserves the right to alter class schedule, rehearsals and performances for any reason either temporarily or permanently without fault.
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I authorize Rising Stars to use my child's photos in promotional print material, website, social media and display boards for Rising Stars.
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I understand that if an increase of COVID-19 rises, Rising Stars reserves the right to move the studio and it's schedule to all virtual classes until we can safely return to in person classes. No refunds will be given for switching to the zoom platform. Tuition rates will remain the same
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I understand that there is a NO REFUND policy but I may withdraw from a class at anytime, forfeiting all payments already made including registration and costume fees. If you wish to withdraw from a class you may submit the request to Miss Mallory with 30 DAYS NOTICE
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