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FUSION DANCE  REGISTRATION 

Breuil Fussion Academy,corp

Student has had the program fully and  complitly explained to him/her and agres to abide by the terms listed in the enrollment Agreement (hereinaffer called Agreement)and by the regulations and polices of Breuil Fussion Academy (hereinaffer called the Academy) This agreement and catalog constitude tne entire agreement between the Academy and the student. The student undertands that if  the Agreement is accepted by the Academy it shall be deemed a binding contract .I hereby enroll at Breuil Fussion Academy for:

Fusion Dance Program 

Class Schedule:          Total clock hours 8/month        Clock Hours per class 1:00/hour        

I Agree
I agree to pay a non-refundable fee of $65.00 and tuition as stated below . Tuition:$70.00/month. 

Family of 2 or more students Tuition:$60.00/each for month.

I Agree
Tuition payment must be made from the 1st-10th of each month. 

​​

I Agree
A lafe of $15.00 will be assessed for late payments. Tuition is late if paid after the 10th of the month.The students liable for all late charges,reasonable attorney's fees and all other costs for the collection of all unpaid fees. Payments may be madr by check or cash.

I Agree
I undertand that tuition charges are for right to attend class wich i am enrollment and no way contingent upon my satisfactory progress, personal satisfaction or placement upon garduation. I further agree to abide by all rules of Breuil Fussion Academy.

The Academy  reserves the right to Withhold the Diploma or Certificate of Completion or dismiss any Student for
maintaining  poor academic standing, excessrve absences, failure to comply with the regulations of the Academy.

I Agree
I understand and agree that although this Agreement is executed for a period of only one (1) quarter, my entrance for  Breuil Fussion Academy for subsequent quarters shall constitute a renewal of the terms of this agreement  except for the 
tuition charges and fees which may be subject to change.

  
I Agree
Credits I understand that the Academy does not confer college credits and that no college credits are accepted by the Academy.

I Agree
EMPLOYMENT ASSISTANCE: The Academy does not guarantee any Student employment upon graduation; however,
Breurl Fussron Academy erI provrde limited placement services as outlined in the Academy Catalog.

I Agree
DISCLAIMER: In the event of a dispute arising out of this Agreement, the Academy shall be entitled to reimbursement of
all reasonable attorney's fees and costs expended by the Academy in the resolution of the dispute or collection of monies
due, and in the event of litigation, the prevailing party shall be entitled to recover reasonable attorney's fees and costs.
Breuil Fussion Academy cannot be held liable if the student is unable to obtain certification due to information not disclosed.

I Agree
REFUND POLICY:
Tuition is paid on monthly basis and due in full at 10th day  of each new month .Should a student’s enrollment be terminated
or cancelled for any reason, all refunds will be made according to the following refund schedule:

1. Cancellation can be made in person, by certified mail or by termination.

2.Official date of termination is the last day of actual attendance unless earlier written notice was received.

3.All refunds will be made within thirty (30) days of receipt of cancellation notice or termination.

4.All monies will be fully refunded if the student cancels within three (3) business days after signing the enrollment
agreement and making initial payment.

5.Cancellation alter the third (3) business days, but before actual instruction begins will result in a refund of all monies paid,
with the exception of the enrollment fee.

6.Tuifion shall also be refunded in full, for the current month, under the following circumstances: course cancelled by the
Academy, involuntary active military duty, documented death of the student, exceptional circumstances, with approval
of the President of the Academy .

7. Cancellation after attendance has begun, but prior to 40% of completion of the program, will result in a pro rata refund
computed on the number of hours completed to the total program hours. A student attending 40% of one month’s
classes will not be entitled to a refund of any tuition paid for that month. Percentage of completion is computed from the
first day of class for the month to last date of actual attendance. Time in which the student is in attendance is the criteria
utilized to determine the amount of the refund. Any amounts determined to be owed Academy as a result of these
calculations are due and payable in full on the effective date of the withdrawal.

I Agree
YOU ARE HEREBY ADVISED TO SEEK THE ADVICE OF PHYSICIAN BEFORE BEGINNING THIS OR ANY OTHER DANCE
OR EXERCISE PROGRAM. The owners and instructors disclaim any liability for losses or injuries sustained in connection with
any advice, activity or demonstration in this dance program.

I Agree
I certify that best of my knowledge I do not have any physical or medical conditions that will be pevent me from participating in this  program. Furthermore, I understand that i will be standing and /or dancing for minimun of two hours at time twice a week. 

          May 8, 2024      

UNIFORM CODE:

Ø    BALLET  SLIPPERS

Ø    BLACK   LEGGINGS

Ø    BLACK    LEOTARD

Ø    HAIR   PICKED UP

Ø    FLAMENCO SHOES

Ø    FLAMENCO  SKIRT

 

I Agree
   DANCERS MUST BRING BOTH FLAMENCO AND BALLET SLIPPERS EVERYDAY. STARTING SEPTEMBER 2, 2014 PINK OR NUDE BALLET SLIPPERS ARE MANDATORY .

I Agree
   DANCERS MUST ALWAYS WEAR A BLACK LEOTARD AND LEGGINGS .

I Agree
   LEGGINGS ARE MANDATORY EVERYDAY FOR THE REASON THAT THEY WILL BE  TAKING OFF THEIR SKIRTS EVERY CLASS.


 

 

First Students Name

First Name*

Middle Name

Last Name*
First Students Age Acknowledgment*
First Students Date of Birth*
I certify that I am 18 years of age or older
First Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
First Students Signature*
Second Students Name

First Name*

Middle Name

Last Name*
Second Students Date of Birth*
Second Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Third Students Name

First Name*

Middle Name

Last Name*
Third Students Date of Birth*
Third Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Fourth Students Name

First Name*

Middle Name

Last Name*
Fourth Students Date of Birth*
Fourth Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Fifth Students Name

First Name*

Middle Name

Last Name*
Fifth Students Date of Birth*
Fifth Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Sixth Students Name

First Name*

Middle Name

Last Name*
Sixth Students Date of Birth*
Sixth Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Seventh Students Name

First Name*

Middle Name

Last Name*
Seventh Students Date of Birth*
Seventh Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Eighth Students Name

First Name*

Middle Name

Last Name*
Eighth Students Date of Birth*
Eighth Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Ninth Students Name

First Name*

Middle Name

Last Name*
Ninth Students Date of Birth*
Ninth Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Tenth Students Name

First Name*

Middle Name

Last Name*
Tenth Students Date of Birth*
Tenth Students Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Keep in touch!!
What would be the best way to communicate with you? *
The previous phone number is the best way to contact me.
I have a different phone number than the emergency contact

Phone Number for Information of the classes, receipt of payments and updates.* *
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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Media Release
Click to customize checkboxes *
Grant permission .I give unrestricted permission for my child's image to be used in print , video and digital media.I gree that these images may be used by Breuil Fussion Academy, corp. for a variety of purposes and that these images may be used without further notifying me. I do undertand that the child's last name will not be used in conjuction with any video or digital images.
Limited usage .I want my child's image used withim the Breuil Fussion Academy setting only ( not in the larger community)
Deny Permission to use my child's image at all.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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