ALETHEIA.

DANCE, INC
SPACE RENTAL APPLICATION

Name of Individual, Artist, Group, Business, Church, Organization, or Corporation:

__________________________________________________________________________________________________
Description of Services: _____________________________________________________________________________

Physical Address:
__________________________________________________________________________________________________
Mailing Address: ___________________________________________________________________________________
Contact #: _________________________________________________________________________________________
Email: ____________________________________________________________________________________________
Contact Person: ___________________________________________________________________________________

Your Reason For Using the

Space:____________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Date(s) of Reservation: ________________________

Estimated Duration (You will be charged an additional 30 cents per minute that you go over your estimated
duration): _______________________________________________________________________________

Event Set Up (include items that you will be using):

__________________________________________________________________________________________________

_________________________________________________________________________________________________

 We will have someone from our staff monitoring the event. We simply ask that you leave the space in the
state that it was in before usage. We ask for a deposit amount equaling the amount calculated based on
your estimated duration. The full amount will be refunded if there are no damages. If damages are found,
we will deduct the amount it cost for repairs from the deposit.

PO Box 6871 Columbia, SC 29260 (615) 378-7064 aletheiadanceinc@gmail.com

 Rental Fees
$20/hr
Deposit- We ask for a deposit amount equaling the amount calculated based on your estimated
duration
Penalty Fee- 30 cents a minute over your estimated duration

CIRCLE YOUR FORM OF PAYMENT

Online
Payment and application must be submitted prior to usage of the space. Your payment can be
submitted at the upper left hand corner of our Tuition & Fees webpage, under the section entitled,
"Misc. Fees." Click on the drop down box, and scroll to "Space Rental."

Check Money Order Cash

Check #_______

Debit Credit
Card #__________________________
Expiration Date: __________________
Security Code: _____________________
Billing Address: _____________________
___________________________________
Card #__________________________
Expiration Date: __________________
Security Code: _____________________
Billing Address: _____________________
____________________________________

PO Box 6871 Columbia, SC 29260 (615) 378-7064 aletheiadanceinc@gmail.com

 RELEASE FORM

*I release and hold harmless Aletheia. Dance, Inc, 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 undersigned, while in or upon the premises or any premises
under the control and supervision of Aletheia. Dance, Inc., its owners and operators or in route to
or from any of said premises. Medical Emergency-The undersigned gives permission to Aletheia.
Dance, Inc., its owners and operators to seek medical treatment in the event they are not able to
reach an emergency contact person. I hereby declare any physical/mental problems, restrictions,
or condition and/or declare that I am in good physical and mental health. I request that my
doctor/physician _________________________ be called and that I be transported to
______________________ hospital.

I hereby grant permission to Aletheia. Dance, Inc, to take and use (check all that apply):
__photographs/digital images
__videotape /digital video
__audio recording
or quoted remarks of myself n promotional or educational materials as follows:
__printed publications or materials
__electronic publications or presentations
__Web sites
I agree that my identity:
__may be revealed
__may not be revealed
in descriptive text or commentary in connection with the image(s)
I agree that the media:
____may
____may not
contact me regarding my involvement with Aletheia. Dance, Inc. activities.

I authorize the use of these materials indefinitely without compensation to me. All negatives,
positives, prints, digital
reproductions and video or audio recordings shall be the property of Aletheia. Dance, Inc.

PO Box 6871 Columbia, SC 29260 (615) 378-7064 aletheiadanceinc@gmail.com

 ALETHEIA. DANCE, INC NON-COMPETE & TRADEMARK POLICY

If I am a business owner, I will abide by Aletheia’s conflict of interest and non-

compete policy in which I will not have an agenda to pull from Aletheia. Dance,
Inc’s clientele for my own service.However, students may freely inquire about my
services on their own terms.

Due to Aletheia. Dance, Inc’s trademark registration process, I will not steal any
ideas, paraphernalia, or funding that belongs to Aletheia. Dance,Inc. I must
receive permission for any borrowed ideas in writing from the Founding Director. I
am allowed to have paraphernalia that is distributed as a free gift from the
Founding Director and staff, but will not claim it as my personal or business
property. If I am found guilty of stealing one of the three, I will not only be
terminated or removed from the program, but I will face whatever legal actions
come with embezzlement and violation of trademark policies.

___________________________________________ ____________________________________________
NAME (PRINTED) TITLE

___________________________________________ ______________________________
SIGNATURE DATE

________________________ ______
FOUNDING ARTISTIC DIRECTOR DATE

PO Box 6871 Columbia, SC 29260 (615) 378-7064 aletheiadanceinc@gmail.com