Howell Dance Company – Credit Card Authorization Form

Electronic Signature Needed: If Howell Dance Company does not receive my payment by the 7th of the month, my tuition payment and a $25.00 late fee will automatically be charged to my above listed credit card. I understand that my monthly tuition is payable by check or cash, due by the 1st of every month and that credit cards that are denied will result in an additional $10.00 fee.

I hereby authorize Howell Dance Company and/or e-online data to bill my credit card for any monthly fees not received into the studio by 7:00pm on the 7th of the month which represents my Late Tuition Payment in accordance to my tuition contract.

I, also authorize Howell Dance Company and/or e-online data to bill my credit card for any outstanding costume, accessory or any competition fees not paid into the studio by the due dates with a $10.00 late fee.
This is my Electronic Signature.

Electronic Signature Needed: As a condition of participating as a student at Howell Dance Company (“HDC”), I, acknowledge that I fully understand the risks inherent to participation at HDC, and I expressly agree, on behalf of myself, my heirs, executors, administrators, successors, and/or assigns, to release and hold harmless Howell Dance Company, April Bamonte and their respective subsidiaries, affiliates, agents, officers, directors, volunteers, managers, other vendors, and employees (each of the foregoing, collectively, the “Releases”) from and against, any and all damages, losses, expenses (including attorneys’ fees and costs) or injuries, and any and all other claims of any type whatsoever for any personal injury, death, disability, or damage to tangible or intangible property, or any other loss, damage, or injury of any nature whatsoever (collectively, “Claims”) relating to or sustained or caused at HDC. Furthermore, I agree, on behalf of myself, my heirs, executors, administrators, successors and/or assigns, to indemnify and hold harmless the Releases from and against any and all Claims made by any third party arising out of my participation at HDC. Such obligation shall not be construed to negate, abridge, or reduce other rights or obligations of indemnity which would otherwise exist as to any party or person described in this Release and Indemnity Agreement. I agree to keep confidential and not to disclose any non-public information, regarding HDC or any of the Releases, disclosed to me during the course of my participation at HDC. I give and grant to Howell Dance Company, April Bamonte and its officers, parent companies, employees, agents, representatives, affiliates, subsidiaries, consultants, independent contractors, successors, assigns, designees and licensees ("LIG"), the right to use and publish my name, nickname, voice, picture, portrait, likeness, characteristics, live or recorded performance, photograph, signature or facsimile thereof, and biographical materials (the “Identity”) as embodied in materials associated with HDC marketing, advertising, sales or promotional efforts (the “Materials”) in all forms of media now known or hereafter created, including without limitation, video, television, print, billboards, point-of-purchase materials, corporate communications, internal and external marketing pieces, and Internet in any and all territories throughout the world. In the event that any clause, term, or provision of this agreement shall be deemed or adjudicated void or invalid, it shall in no manner affect the validity or enforceability of the remaining clauses, terms, and provisions herein which shall remain in full force and effect. I hereby acknowledge that I have read the Release and Indemnity Agreement and am satisfied that it is fair and equitable. I shall not revoke this consent and approval. I have read and understand the Howell Dance Company liability release and indemnity agreement: This is my Electronic Signature.