By signing below, I acknowledge receipt of the handbook/calendar and understanding of the policies related to participation in Harbor School of Music & Dance programs, including commitment and behavior expectations, absence and payment policies, etc. (available at www.myhsmd.com). I have read and signed the liability release form (see back). Also, I agree to payment terms as outlined on payment form. I understand that any change requests to tuition payment terms, including cancellation of participation/payment, must be made in writing at the office. Scheduled Debit Terms: Signed authorization is to remain in full force and effect until the Harbor School of Music & Dance has
received written notification of its termination in such time and manner as to afford HSMD a reasonable opportunity to act on it
or until the term of authorization expires. Notice shall be completed in person at the HSMD school office: 3691 Ben Walters Lane,
Suite 2, Homer, AK, 99603.
Declined Payments Policy: All tuition installments are due on the 1st of the month and an attempt will be made to charge the account
on file with the school at this time. Should any payments decline, a second attempt will be made on the account on file on
the 5th of the month. Should the card on file with the HSMD decline on the second attempt, an attempt to contact the accountholder
will be made via phone, text or email as appropriate. Any payments made after the 10th of the month will incur a late fee
of either $10.00 or 5% of the total due, whichever is greater.
Note: All payment terms are subject to a 30-day written cancellation policy. Your cancellation of tuition payment
terms will be dated from the day you complete a withdrawal form in our office. You are responsible for tuition for
30 days from date of written notice. Re-enrollment in the school is subject to availability and will require one month's tuition installment due at time of re-enrollment. Early withdrawal students forfeit any remaining make up lessons or recital fees and are not eligible for priority registration. 

 Liability Release
As the legal parent or guardian, I release and hold harmless the Harbor School of Music & Dance, its owners,
operators, and teachers 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 Harbor School of Music & Dance, its owners and operators or in route to or from any of said premises.
In case of medical emergency: The undersigned gives permission to the Harbor School of Music & Dance, its
owners and operators to seek medical treatment for the participant in the event they are not able to reach a
parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare
the participant to be in good physical and mental health.
Photography Release
By registering your student, the school is hereby granted permission to take photographs or video of the student to
use in brochures, web sites, posters, advertisements and other promotional materials the school creates.
Permission is also hereby granted for the school to copyright such photographs in its name. 

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