Student Details
Contact Information
PARENT INFORMATION (if the student is under 18)
Mother
Father
AUTHORIZED PICK-UP (other than parents)
EMERGENCY CONTACT – (Closest Relative/Friend)
- To Be Paid in full amount during the first class of the month for the total amount of
four classes per month.
- No tuition fee refunded for any missed class.
- Make up class is arranged only due to teacher’s absence.
- No classes on holidays.
Who's Responsible for paying tuition fees?
RELEASE/Waiver Form: (Must Read and Sign, Please.)
I have read this release and understand its meaning.
I certify that I am / my child is in proper physical condition to take part in the class. I realize
that there are certain risks possible in the art of Dancing. I agree to assume the risk of all
injuries that may arise from my / my child’s participation in the classes at Payal Kathak Joy.
In consideration of the above, I hereby release and hold harmless Payal Kathak Joy, its
teachers and the Director from and against any liability or claim for any loss of property,
injury, misadventure, harm, cost or damage sustained as a result of my / my child’s
participation in classes at Payal Kathak Joy.
You, the undersigned, on behalf of yourself and any dependent(s), represent and agree as
follows:
(a) I/My child understand that the use of the Payal Kathak Joy facilities, equipment, services,
programs and premises includes an inherent risk of injury to persons and property;
(b) I/My child am in good physical condition and have no disabilities, diseases, illnesses or
other concerns that could prevent me/us from exercising and using the Payal Kathak Joy
facilities without injuring ourselves or impacting our health; and
(c) I/My Child have consulted a physician concerning any exercise program that will expose
me/us to risk of injury or impairment to our health and that our physician has approved our
contemplated activities at the Payal Kathak Joy facility.
I/My Child understand that risk of injury includes but is not limited to injuries arising from or
relating to the use by me or my dependents or others of exercise equipment, dressing rooms,
other areas and other Payal Kathak Joy facilities; injuries arising from or relating to
participation by me or others in supervised or unsupervised activities or programs throughout
the Payal Kathak Joy school facilities; injuries and medical disorders arising from or relating
to the use of the Payal Kathak Joy facilities such as heart attack, stroke, death, heat stress,
sprains, strains, broken bones, and torn muscles, tendons and ligaments, among others, and
accidental injuries occurring anywhere in the Payal Kathak Joy School’s facilities, including
lobbies, hallways, exercise areas, dressing rooms or activities associated with the Payal
Kathak Joy School which are carried on anywhere or while we are traveling to or from the
Payal Kathak Joy Facilities. Accidental injuries include those caused by me/us or caused by
other persons and those of a slip and fall nature.
For any special exercise requirements or limitations, I/My Child agree to disclose them to the
Payal Kathak Joy Office before using the Payal Kathak Joy School’s facilities or when
seeking help in establishing or carrying on an exercise program. I/My Child hereby agree that
all exercise and use of Payal Kathak Joy equipment and services and programs are
undertaken by me/my child at my/our own sole risk.
By my execution thereof, I hereby waive all claims which myself or any dependent may have
hereunder against the Payal Kathak Joy School, and to hereby release the Payal Kathak Joy
School on my behalf and on behalf of any dependents, and agree to hold the Payal Kathak
Joy School absolutely harmless from all claims, demands, injuries, damages, actions, suits, or
causes of action to persons or property, arising out of or in any way connected with me or my
dependents use of the Payal Kathak Joy School facilities premises, equipment, services or
programs, including those arising out of any active or passive negligent act or omission of the
Payal Kathak Joy School, except as to such which may arise from the gross negligence or
property damage due to the negligent act or commission of the Payal Kathak Joy School.
I acknowledge that I have carefully read this Waiver and Release, and fully understand it is a
release of liability. I am waiving any right that I and/or my dependent may have to bring a
legal action to assert a claim against the Payal Kathak Joy School for more negligence.