402-289-3332 / lmedhi@ae-pc.com

2705 N Main Street, Elkhorn, NE 68022

The                      DANCE Studio

RELEASE AND WAIVER OF LIABILITY: (By checking the above you acknowledge this statement)


I, r
elease 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.

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.


There is an annual registration fee of $25 per student or $35 per family for the Regular Dance Season ONLY which runs from September to end of May.  *Nonrefundable processed when you register.


Basement Showcase fee of $35 per student, plus $15 group tshirt which is nonrefundable processed in February, 2017


Showcase costume fee paid in two installments for total of $50 to $100 based upon class costume.

October 1, 2016 and November 1, 2016


No registration fee for the 6-week sessions!


6 week sessions must be paid for in advance of first class, payment may be made by mailing payment to:  The Basement Dance Studio, 2705 N Main Street, Elkhorn, NE 68022

Please submit the form, you will receive confirmation back via email generally within 24-48 hours!


RELEASE AND WAIVER OF LIABILITY FOR FLASHMOB: (By checking the above you acknowledge this statement)

By agreeing to this release, it is understood that there is potential risk of injury participating with The Basement Dance Studio at the flashmob on October 28th at 7 pm and has examined the potential risks from the activity and voluntarily assumes these risks.  It is also understood that 168th & Dodge LP (“RED”), owner and operation 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 acknolwedged checkmark 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(s) and/or the understigned and their respective heirs, executors, administrators or assigns now have or evre might have rresulting from participation in the Activity.  

I HAVE READ AND UNDERSTAND THIS “RELEASE AND WAIVER”, again by checking box acknowledges this statement!