The Royal Academy Summer Camp

Name of Child *

First Name

Last Name

Name of Child #2 (if applicable)

First Name

Last Name

Name of Parent/Guardian who will be dropping off and picking up *

First Name

Last Name

Name of Parent/Guardian who will be dropping off and picking up

First Name

Last Name

Best Phone # where you can be reached in case of emergency *

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Terms

Liability Release: I hereby give my consent for my child to participate in classes and activities at The Royal Dance Academy. I am fully aware and appreciate the risk and damages that might occur as a result of participating in classes and activities. I have been assured that all precautions will be taken to ensure my child’s safety. I hereby waiver and release any and all rights or claims for any damages my child may have against Upper Valley Princess Parties(UVPP), its staff, employees, teachers and agents for any and all injuries sustained or suffered by my child at any Royal Academy class or activity. Medical Release: I understand that it is my responsibility to provide all medical insurance coverage. That I must inform UVPP of any medical condition that is present or may occur and may affect my child/self training while enrolled in classes. In the event I cannot be reached, I hereby give my permission to the staff of UVPP to authorize any emergency medical care that may be required by the above student during my child/self participation in classes, performances, or any related UVPP event. This authorization extends through the current year or until my child is no longer enrolled in The Royal Academy, whichever comes first. I understand that I am responsible for any and all charges as a result of such care or medical treatment. Publicity Release: I hereby authorize UVPP to record my child/self through pictures, photographs, and videos and to edit these recording sat its discretion and to incorporate these recordings for UVPP to use for publicity including advertising and sales promotion. I acknowledge that no promises of compensation have been made by UVPP for such use. Payment Conditions: I am solely responsible for the entire Royal Academy's tuition regardless of attendance.• Tuition is required to be paid in full before classes start. I will pay a handling fee of $20 for all returned or declined payments. • All tuition payments are final. No Refunds for days missed due to illness, injuries, vacation, or participation in other activities.• Adjustments may be made only upon receipt of written notification at the discretion of the director.

I have read the registration information and understand the School’s policies as outlined. My signature below indicates that I understand and accept the following: Liability Release, Medical Release, Publicity Release and Payment Conditions.

If you do not want your childs photo used please indicate here.