REFUSAL TO CONSENT. I do not give my consent for emergency medical treatment for my minor child. Please contact me immediately. Signature of parent/guardian Date Class Enrollment MONTHLY AND SEMESTER DISCOUNTS CANNOT BE COMBINED Name of Class Day $ Name of Class Day $ Name of Class Day $ Name of Class Day $ Name of Class Day $ Name of Class Day $ IF PAYING BY MONTH Total Monthly Amount Due $ Subtract 5% Discount over 1 class per month % Total Monthly Payment $ Add first and last month (February/June) $ First Child Registration fee: $45.00 Additional Child Registration Fee: $30.00 Total Due:
REFUSAL TO CONSENT. A. If any owner, part-owner, partner, principle party, officer, agent, or employee refuses to submit or consent to a criminal records check including fingerprint identification, the Police Department shall deny any owner, part-owner, partner, principle party, officer, agent, or employee as eligible to perform any work related to this contract.
REFUSAL TO CONSENT. I DO NOT give consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the Shorin Ryu Karate Academy, LLC and its instructors and/or agents to take NO ACTION or to: Signature of Parent / Guardian Date
REFUSAL TO CONSENT. I do not give my consent for emergency medical treatment for my minor child. Please contact me immediately. Signature of parent/guardian Date
REFUSAL TO CONSENT. I do not give my consent for emergency medical treatment for myself. Please contact me immediately. Signature of Student 18 & Up Date 2021 Session Dates – All Classes are held on Thursdays, 8:15pm-9:15pm January 6-February 24th Pricing per 8 Week session $75.00 per person Payments can be mailed to JAM Dance Academy, 00000 Xxxxxx Xxxxx Xxxx, Xxxxx Xxxxxxxxxx, XX 00000 or emailed to xxxx@xxxxxxxxxxxxxxx.xxx No refunds will be given if student does not attend all classes. Payments must be received 7 Days prior to the start of each session. No refunds. Total Due: $ Cash Check CREDIT CARD PAYMENT: PLEASE PRINT LEGIBLY CC # CVC CODE: EXP DATE: ZIP CODE: I AUTHORIZE THE 5% CONVENIENCE FEE FOR THIS CHARGE: X INITIAL Payments can be made in the form of a check, cash or credit card. A $30.00 charge will be assessed for any returned checks. Should a credit card decline, you will need to make your payment with another form of currency. Late fee will still apply if not paid. Checks may be made payable to JAM Dance Academy. X INITIAL Missed classes will not be refunded. No refunds/credits will be given. X INITIAL Attire Anything comfortable for you that you can move in. Street shoes are NOT permitted on the studio dance floor. Any type of ballet slipper or tight socks. Hair up and off of face.
REFUSAL TO CONSENT. Refusal to consent to drug/alcohol testing will be considered a positive test and an insubordinate action by the employee. An employee's failure to submit to drug and/or alcohol testing required by the City for any reason may result in disciplinary action, up to and including termination, according to City policy. The following behaviors constitute a refusal to submit to a test: refusal to take the test (verbal refusal or physical absence), inability to provide sufficient quantities of breath or urine without a valid medical explanation, tampering with or attempting to adulterate the specimen or interfere with the collection procedure, not reporting to the collection site in the time allotted, leaving the scene of an accident without a valid reason before the tests have been conducted, refusal to remove outer garments or leave them outside the testing area, and refusal to empty pockets. Where there is a reasonable suspicion that the employee is then under the influence of alcohol or drugs, employee shall not return to work prior to completing all requirements for return-to-duty. Human Resources shall arrange for the employee to be safely transported home after testing. An employee shall not be permitted to transport him/herself.
REFUSAL TO CONSENT. An employee who refuses to consent to a drug and alcohol test when reasonable suspicion of drug or alcohol use has been identified is subject to disciplinary action up to and including termination. The reason (s) for the refusal shall be considered in determining the appropriate disciplinary action.
