Sturbridge Studio Program Registration Form Please note: 1st month tuition PLUS $30 registration fee is due through this online system Medical Conditions: YesNo *if Yes, please give details and/or attach medical information Upload File: Acceptable file types: jpg,jpeg,png,gif,txt,doc,docx,pdf,zip,rar. How did you hear about MMD Sturbridge: ---FriendWebEmailNewspaperOther Other: Liability Release: I, the parent/guardian of (student’s Name) , do hereby consent to my child’s participation in dance lessons, instructional programs, recitals and other activities provided by Mass Motion Dance. I do realize that dance is a physical activity and that there are risks involved. In consideration of my child receiving services as described above, I agree to release, hold harmless, and indemnify Mass Motion Dance and its owners Terri Gordon and Katherine (Hooper) Hammer, their employees, agents, instructors and officers from any and all claims, actions, causes of action, damages, and attorney fees, arising from personal injuries that may be sustained by my child resulting from participation in the programs provided by Mass Motion Dance. Photo Liability Release: I allow pictures of my child to appear on the Mass Motion Dance website. Initial: Tuition Payment Agreement: I understand that by signing this agreement, I am committing to pay a monthly tuition of $ on the 1st of each month for a total of 10 months, September through June. Cancellation policy: Students that decide to stop taking classes throughout the year must provide a 30 day written notice prior to 1st of following month.