Ridgewood Irish Dance Online Registration

Registration

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If you are a new student, please fill out the form below. If you are a returning student, please log into the customer portal to register. Registration and 1st payments are due at time of registration. You may pay tuition in full or choose monthly. If you are registering for CAMP RINCE NUA 2018 non refundable deposit of $250 is due a time of registration.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Student's Last Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

Grade Level as of Sep 2018*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Please tell us what current level your dance is, Beginner, Intermediate, Novice, Prizewinner, Champ*

CAMP ONLY:Dance School Name

To register for a class, select "Search." In the pop-up window, please select the class you would like to register for. Pay careful attention to the day and time of the class to make sure you are registering for the correct class. Make sure you are only selecting classes for the student whose information you have entered above. If you have more than one student, proceed to Student #2 below for your second student, etc. (Click on the box next to Show-Hide Details)

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

Grade Level as of Sep 2018*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Please tell us what current level your dance is, Beginner, Intermediate, Novice, Prizewinner, Champ*

CAMP ONLY:Dance School Name

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

Grade Level as of Sep 2018*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Please tell us what current level your dance is, Beginner, Intermediate, Novice, Prizewinner, Champ*

CAMP ONLY:Dance School Name

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

Grade Level as of Sep 2018*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Please tell us what current level your dance is, Beginner, Intermediate, Novice, Prizewinner, Champ*

CAMP ONLY:Dance School Name

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

Grade Level as of Sep 2018*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Please tell us what current level your dance is, Beginner, Intermediate, Novice, Prizewinner, Champ*

CAMP ONLY:Dance School Name

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Release of Liability

As the legal parent or guardian, I release and hold harmless Ridgewood Irish Dance/The JIG factory, Camp Rince Nua, 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 Ridgewood Irish Dance, The JIG factory, Camp Rince Nua, its owners and operators or in route to or from any of said premises.

I've read the above and agree.

Media release

As the parent or legal guardian of child/children I hereby give permission for Ridgewood Irish Dance LLC, The JIG Factory, Camp Rince Nua its assigns, licensees and legal representatives the right to use my dancers image, likeness, picture, or photograph for the purpose of display, advertising, website, or publication and in all forms of media, including electronic media and/or composite representations, for advertising, trade, or any lawful purposes.

I've read the above and agree.

Signature Text

As the legal parent or guardian, I release and hold harmless Ridgewood Irish Dance, The JIG factory, Camp Rince Nua, 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 Ridgewood Irish Dance, The JIG factory, Camp Rince Nua, its owners and operators or in route to or from any of said premises.

I've read the above and agree.

Medical Emergency

The undersigned gives permission to Ridgewood Irish Dance, The JIG factory, Camp Rince Nua, 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, restictions, or condition and/or declare the paricipant to be in good physical and mental health.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip