Single Payment and Billing Change Form

Today's Date +

Name of Customer *

Your Email Address: *

What do you want to do with your membership? *

I wish to terminate my membership

I wish to convert my membership as is to a recurring monthly pledge

I wish to convert my membership (or update existing pledge) to a new monthly pledge amount I wish to convert my membership (or update existing pledge) to a new monthly pledge amount

What kind of billing update are you making? *

Update Billing for a one-time charge

Update Billing for recurring event, membership pledge, or payment plan

What is this one-time charge for? *

What is this recurring billing for? *

What Kind of Event are you paying for? *

If "Other" please describe *

How would you like to follow The Story School? *

Sign me up for the newsletter

Add me to a volunteer list for digital events/tasks

Add me to a volunteer list for physical events/tasks

Add me to all donation request lists

None of the above

----------------- RISK AND MEDIA AGREEMENT UPDATE ----------------- Please read the following before signing below

This waiver is required by our insurance company. However, you should know that The Story School staff are trained extensively in running safe, entertaining, and educational classes and events. Our safety record is exceptional. Our staff work hard to keep participants safe and the swordplay at an acceptable level, but we acknowledge that accidents happen (someone may get hit in the head with a foam sword, trips and falls are common, collisions can happen from excited kids who aren’t looking where they are going, etc.). We ask that you work with us to help embrace the The Story School environment and activities with the understanding that participants who are active are at a higher risk of injury than those who are not. They are also at a higher risk of having more fun.

Definition: "Company" refers to The Story School Inc..

I understand that the above named will be held to a standard of conduct during this event. Failure to abide by safety rules will result in a warning or expulsion from the event without refund. I also understand that these events may include special effects and costuming that is considered frightening to some children. I also understand that the above named may learn, use, and be hit by a foam, foil, or practice weapon of some sort by other participants and/or staff during this event. I understand/have helped the above named to understand that I/they may decline to participate in any part of the event. I also understand that refusal to participate does not constitute grounds for refund of fee. I give the Company permission and consent for photos/videos to be taken of the above named during activities, and for these to be used for promotions in brochures, press releases, and other media.

By signing up the above named for this event, I acknowledge and understand that the participant will be voluntarily engaging in activities that may involve contact and the risk of serious injury, permanent disability, or death, and may cause severe social or economic losses due to not only the participant’s actions, inactions, or negligence, but also to the action, inactions, or negligence of others or conditions of the premises or of any equipment used. Further, I agree that I will not, nor will anyone acting on my behalf claiming by or through me, bring or maintain any suit in Court to assert any claim against the Company and/or any instructors/assistant instructors/staff for any claim that I might have arising out of the above named participation in any activities performed by, directed by, or endorsed by the Company or the instructors/assistant instructors. I agree to pay for any and all expenses (including but not limited to any medical expenses) that might relate to the participant’s care and treatment.

Print Participant's Full Name: *

(If participant listed above is under 18) Print Parent/Legal Guardian's Full Name for Signature
(Leave as is if the participant is over 18)

Electronic Signature Consent

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary. *

The Story School, Inc. 129 Pleasant Street (781) 214-1174