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REGISTRATION FORM

Payment Policy

  1. Annie’s Playhouse LLC has a strict NO REFUND POLICY. For no reason will tuition be refunded or credited, including inability to participate in class or lessons for any reason. I understand that by signing this form, I am being charged the full tuition of the class, and agree to the no-refund policy stated. If payment has been made by cash or check, the same policies apply once payment has been submitted.
  2. Annie’s Playhouse LLC does not pro-rate tuition for students who register mid-session. Tuition cannot be transferred from one student to another, even if they are members of the same family. Likewise, unused tuition cannot be applied as credit to other purchases within Annie’s Playhouse LLC.
  3. Annie’s Playhouse LLC reserves the right to cancel or change class dates, times, location, and prices if needed due to scheduling, demand, and enrollment. Low enrollment may result in cancellation or consolidation of classes. If a class is canceled, you will be offered an alternative class or receive full credit of all fees that can be used for any Annie’s Playhouse class within the semester you have registered.
  4. I hereby authorize Annie’s Playhouse LLC to charge the credit card provided, and deposit any cash/checks submitted, to pay for all fees associated with the student on this form. I acknowledge that this registration form is used to renew all private lessons during any semester my child is registered. Likewise, I authorize Annie’s Playhouse LLC to automatically renew my tuition for future semesters and lesson packages with the credit card information provided.
  5. If registration has been confirmed by phone or email, I agree to abide by all policies stated on this registration form

Private Lesson Policy

  1. Securing Your Lesson Time - Lessons must be PURCHASED IN PACKAGES. PAYMENT MUST BE PAID IN FULL WHEN YOU BOOK your lesson time. We cannot guarantee your time slot from semester to semester
  2. Cancellation Policy - LESSONS MUST BE CANCELLED 24 HOURS IN ADVANCE. No exceptions. If lessons are canceled 24 hours in advance, your lessons will resume the following week at your regularly scheduled day and time. Any outstanding lessons passed the end of the semester of your start date will expire.
  3. Tardiness - If you are MORE THAN 5 MINUTES late your lesson time will not be extended.
  4. Materials - Please note: ALL LESSONS REQUIRE A $50.00 MATERIALS FEE. Please value your private lesson materials. Your songs, method books, and recordings are all valuable and are vital to your progress. You are required to bring your materials to your lesson each week. Any lost material will be replaced at cost to the student. Special recordings/arrangements are an additional fee. Please contact Annie with any requests, comments, questions or feedback regarding your private lesson.
  5. If 2 or more consequtive lessons are missed, you lesson time may be forfieted.

Release and Waiver of Liability

  1. The undersigned hereby agrees to RELEASE,WAIVE, INDEMNIFY, HOLD HARMLESS AND COVENANT NOT TO SUE Annieʼs Playhouse, LCC itʼs employees, instructors, volunteers, or owners for any claim, cause of action, loss, damage, or tort arising out of or related to the registered students participation in class,rehearsal, performance or other time the student is left under the supervision of Annieʼs Playhouse LLC employees or volunteers, on or off the premises.
  2. The undersigned hereby ASSUMES FULL RESPONSIBILITY FOR ANY AND ALL RISK OF BODILY INJURY, DEATH, PROPERTY LOSS OR DAMAGE due to negligence or otherwise while said student is participating in Annieʼs Playhouse LLCʼs class,rehearsals, performances or other time the student is left under the supervision of Annieʼs Playhouse LLC employees or volunteers, on or off the premises.
  3. The undersigned EXPRESSLY ACKNOWLEDGES AND AGREES that some of the activities during classes,rehearsals, and performances hold the possibility of substantial risk and/or death and/or property loss/damage. The undersigned nevertheless expressly agrees that the foregoing RELEASE AND WAIVER is intended to cover all such activities. Annieʼs Playhouse, LLC is not responsible for any lost or stolen property at anytime.
  4. If any portion of this RELEASE AND WAIVER OF LIABILITY is deemed invalid, it is agreed that the balance of the RELEASE AND WAIVER OF LIABILITY remains in full force and effect. The undersigned also expressly agrees that (s)he has READ AND VOLUNTARILY SIGNED THE RELEASE AND WAIVER OF LIABILITY and further agrees that no oral representation statement or inducement not contained herein was made or relied upon in executing this document

Media Release

  1. The undersigned hereby understands and agrees that the registered student may be participating in Annieʼs Playhouse, LLC activities and performance where said student may be photographed, videotaped, or recorded by any means known or yet to be invented.
  2. The undersigned GRANTS ANNIEʼS PLAYHOUSE, LLC COMPLETE EXCLUSIVITY TO THE USE OF THESE IMAGES AND/OR RECORDINGS IN ALL FORMS OF MEDIA THROUGHOUT THE WORLD (inclusive of but not limited to: print, professional video, home-video, CD-ROM, internet, DVD, audio CD, and any other electronic medium presently in existence or invented in the future). The previously mentioned images, and recordings become the Property of Annieʼs Playhouse, LLC.
  3. The undersigned hereby agrees to RELEASE,WAIVE, INDEMNIFY, HOLD HARMLESS AND COVENANT NOT TO SUE Annieʼs Playhouse, LCC itʼs employees, instructors, volunteers, or owners for any claim that anything contained in the Property, or in advertising and publicity used in connect herewith, is defamatory,reflects adversely on the undersigned or said student, violates any other right whatsoever, including,without limitation, rights of privacy and publicity.
  4. Annieʼs Playhouse, LLC shall have the right to assign its rights hereunder,without my consent, in whole or in part, to any person, firm, corporation or organization

Medical Release

  1. The UNDERSIGNED REQUESTS and AUTHORIZES that Annieʼs Playhouse, LLC, its owners, members, employees, staff, and volunteers to act on their behalf, in the case of a MEDICAL EMERGENCY. The undersigned requests that in the event of a medical emergency the student be admitted to any hospital or medical facility for any type of diagnosis and or treatment that is deemed medically necessary.
  2. The undersigned requests and AUTHORIZES PHYSICIANS, DENTISTS, SURGEONS and STAFF, duly licensed as Doctors of Medicine/Osteopathy or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the registered student/participant.
  3. The undersigned has not been given any GUARANTEE as to the results of examination or treatment. The UNDERSIGNED AUTHORIZES Annieʼs Playhouse, LLC, its owners, members, employees, staff and volunteers to act for the student according to their BEST JUDGEMENT in PROVIDING OR ARRANGING for EMERGENCY CARE in any emergency circumstance requiring medical attention.
  4. The undersigned AUTHORIZES the hospital, medical or care facility to dispose of any specimen or tissue during the course of any diagnosis, treatment or other normal customary procedures. The undersigned AGREES TO BE RESPONSIBLE for all charges incurred by any hospitalization, treatment, or medical transportation.

Transporation and Activity Day Release

  1. The undersigned hereby authorizes and give permissions for their child to be transported by an employee and/or a representative of Annie’s Playhouse, to or from Annie’s Playhouse. The undersigned agrees to release and hold harmless Annie’s Playhouse, any volunteers, coordinators,representatives, officers, agents employees and/or designees of Annie’s Playhouse, or anyone acting on its behalf from any liability to your child which may arise as a result of your child being transported to or from Annie’s Playhouse.
  2. The undersigned recognizes that by participating in this activity, as with any activity involving motor vehicle transportation, their child may risk personal injury or permanent loss. The undersigned attests and verifies that they have been advised of the potential risks, and has full knowledge of the risks involved in this activity. The undersigned also agrees to assume any expenses that may be incurred in the event of an accident, illness, or other incapacity regardless of whether they have authorized such expenses.
  3. The undersigned gives consent for their child to participate in swimming activities during the summer camp program. They understand that by participating in this activity, as with any swimming event, their child may risk potential injury or permanent loss. The undersigned agrees to release and hold harmless Annie’s Playhouse, any volunteers, coordinators,representatives, officers, agents employees and/or designees of Annie’s Playhouse, or anyone acting on its behalf from any liability to their child which may arise as a result of their child participating in a swimming activity."

Date: December 9, 2019

 

I here by authorize Annie’s Playhouse, LLC to use the credit card information that I have provided to pay for any fees associated with the enrollment of the student named above. I understand that the credit card transaction may occur before or after the date of registration noted above.I agree to pay the total amount in full using the agreed upon method of payment for all semesters and lesson packages.

I have read and understand the PAYMENT/NO REFUND POLICY information and agree to them.
Checks payable to Annie’s Playhouse

First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
First Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
How you heard about us?

How you heard about us? *
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Age: (If Under 18)

School Attended: *

Zip Code: *

City: *
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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