2016-17 Registration Form

Before filling out this form, make sure you have seen the 2016-17 full class schedule, which is now available online on this site, and is also available as a pdf.

This registration form is also available online as a pdf, which can be printed out and brought to the studio.

Part I: Student information

Student's Full Name(*)
Please type your full name.

Student Status(*)
Please specify your position in the company

Date of Birth(*)

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Age as of 9/1/2016(*)
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Part II: Parent Information

Parent Name(s)(*)
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Street Address(*)
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City(*)
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Zip(*)
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Home Phone(*)
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E-mail(*)
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Cell Phone
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Cell Phone 2
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Emergency Contact
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Emergency Contact's Phone
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Below, please list any medical and/or behavioral information relevant to dance class participation including food allergies.

Medical/Behavioral Information
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Part III: Classes

Please select all of the classes your child will be attending. Be sure you check the most recent schedule, which is now available on the site.

Beginner Classes
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Intermediate and Advanced Classes
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Performing Company
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Terms and Conditions(*)
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I grant permission for the above-named student to participate in dance instruction and activities provided through Ni Riain School of Irish Dance. I further agree to indemnify and hold harmless Ni Riain School of Irish Dance and each of their officers, independent contractors, leaders, teachers and volunteers from any and all liability and expenses with respect to claims for all damages or losses that may be asserted by their participation in instruction and activities developed, coordinated and/or conducted by Ni Riain School of Irish Dance both on and off the premises.

I acknowledge that medically trained staff is not available during classes, performances, and activities, and that I am responsible for monitoring my child’s serious health issues and providing care and attention as needed. I also understand that it is my responsibility to make staff and volunteers well aware of any allergies or restrictions on a continuing basis, as I am ultimately responsible for my child’s health.

I understand that photographs of my child may be used in Ni Riain School of Irish Dance presentations and publications, in newspapers and media, and/ or published on the Ni Riain website, unless I expressly request, in writing, that photographs of my child not be used for such purposes.

I verify that all information on this form is true and correct, agree to update the information as needed, and acknowledge that I have access to and understand the 2016-17 Tuition Rates & Policy.

Anti-Spam(*)
Anti-Spam
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About Irish Dance

Below are links to some basic information about Irish Dancing

  • Irish Dancing Terms (coming soon)

  • About Competitions (coming soon)