Name of Student
Class Registering For
Starting Date
Preferred Lesson
Private Lessons
Semi-Private
Group Lessons
Other
Date of Birth
Participant Age
How did you hear about us?
List any medical/health issues including allergies that Crossing Borders needs to be aware of below:
Responsible Party
E-mail Address
Occupation
Employer
Street Address
City
State
Zip Code
Home Number
Cell Number
Work Number
Policy on Payment, Withdrawals, Cancellations, and Refunds
Each student must fill out a registration form yearly. A yearly fee, per student, is required at time of registration; this fee is not refundable or transferable.
All tuition and all other fees must be paid in full before first class can be schedule. All credit must be used within four months after payment or you will lose your credit.
Group Classes: There are no make-ups for group classes a student misses. There are no prorates or refunds once class begins. Non-attendance does not constitute cancellation or withdrawal. A written withdrawal thirty (30) days prior needs to be turn in to our office.
Private Classes Only: Rescheduling for a lesson must be received by the instructor and/or Crossing Borders representative a minimum of
twenty-four (24) hours prior to class time or for classes schedule on Mondays, by 3:00 P.M. on Friday. Further, when the student/Responsible party gives less notice than the previously stated or who no-show for a lesson, agrees to pay for missed lesson in full .
Withdrawal on or after the first day of class does not relieve the student/responsible party from liability for tuition or other fees.
Cancellation made for students who have registered, made payment, and who subsequently notify Crossing Borders of cancellation one week before the first day of classes are eligible for a full refund on tuition only and a $30 cancelation fee will be added. There will be NO refunds on the registration
or the material fees. All refunds will be made by check thirty (30) days after receiving the written notification and check will be send only by mail to
the address above. Students who prefer to keep their payment as a credit to be used in the future MUST USE IT WITHIN SIXTY (60) DAYS of the date
the credit was issued, at the end of this period the money will NOT be refunded and credit will be lost.
I Accept the above payment agreement
Medical Release and Waiver of Liability
I know of no mental or physical problems, which might affect the ability of the individual named herein to safely participate in this program. I am responsible for notifying Crossing Borders of any changes in the participant’s health or physical/mental condition, which might affect his or her ability to safely participate in any programs in which he or she is enrolled.
I hereby authorize the directors of Crossing Borders to act on their best judgment in any apparent emergency requiring medical attention for myself or
the participant named above.
I hereby waive, release, and indemnify Crossing Borders staff and facility location of all legal responsibility in the event of any injury to myself or the
participant named herein. I waive and release Crossing Borders from and against any and all claims, actions, causes of action, damages, costs,
liabilities, and expense of judgments (including attorney’s fees and court costs) arising out of participation in this program.
I hereby execute this Waiver & Release form to induce Crossing Borders to permit me to participate in this program.
I Accept the above medical release and liability waiver
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