RELEASE AND WAIVER OF LIABILITY: (By checking the above you acknowledge this statement)
I, release and hold harmless The Basement, LLC, its owners, instructors and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, I release and hold harmless The Basement, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of The Basement, its owners and operators or in route to or from any of said premise sustained by the participant.
FOR OCTOBER 27, 2018 Flashmob waiver release
“The undersigned states that he/she understands that there is potential risk of injury participating with the Basement Dance Studios Flashmob on Saturday, October 27th and has examined the potential risks from the Activity and voluntarily assumes these risks. The undersigned further understands that 168th and Dodge LP (“RED”), owner and operator of Village Pointe Shopping Center is not and shall not be responsible or liable for any illness, injury to person or damage to property resulting in whole or in part from the Activity. The undersigned (and the participant if the undersigned signs on behalf of a participant who is a minor or under other legal disability), hereby forever releases and holds harmless RED, its members, employees, agents and representatives, from any and all claims of any kind, whether now known or unknown, that the participant and/or the undersigned and their respective heirs, executors, administrators or assigns now have or ever might have resulting from participation in the Activity.
I HAVE READ AND UNDERSTAND THIS “RELEASE AND WAIVER” (Registration invalid without signature of all persons having legal custody of children under 18 years of age):”
PAYMENT AND TUITION (Pertains to regular dance season classes only: (By checking the above you acknowledge this statement)
I, the legal parent or guardian, understand that tuition is due by the 5th of each month, all tuition is set up via ACH out of bank account of client’s choice. There will be a $25.00 ACH charge for insufficient funds. Tuition is based on the number of monthly classes enrolled in, we do not prorate months for missed days, holidays, inclement weather closings or school vacations. ACH form will be provided to you after you register online and must be returned PRIOR to class beginning, details in Studio Handbook.
402-289-3332 / lmedhi@ae-pc.com
2705 N Main Street, Elkhorn, NE 68022
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