Class Registration

2020/2021 Class Registration

* Indicates required field

Parent/Guardian Name *

First

Last

Parent/Guardian Name *

First

Last

Email *

Secondary Email *

Phone Number *

Address *

There is a $20 registration fee ($40 family registration fee) that is due at the beginning of each school year. You will receive an emailed invoice after submitting this form.

Tuition rates are listed on our school policies page: http://www.heartlandirishdancers.com/school-policies.html

Student Info

Student #1 Name *

First

Last

Student #1 Birth Date *

Student #1 Class Name *

Student #1 Class Location *

Student #1 Class Name (if taking more than one class) *

Student #1 Class Location Second Class *

Student #2 Name *

First

Last

Student #2 Birth Date *

Student #2 Class Name *

Student #2 Class Location *

Student #2 Class Name (if taking more than one class) *

Student #2 Class Location of Second Class *

Student #3 Name *

First

Last

Student #3 Birth Date *

Student #3 Class Name *

Student #3 Class Location *

Student #3 Class Name (if taking more than one class) *

Student #3 Class Location of Second Class *

Medical and Emergency Info

Please list any allergies/medical conditions that we should be aware of for each dancer... this will be kept confidential. *

Emergency Contact Name (if parents can't be reached) *

First

Last

Emergency Contact Phone Number *

Family Liability Agreement

Click here to review the HID school rules and tuition policies

Heartland Irish Dancers recognizes its obligation to make sure our students and their parents (if student is a minor) are aware of the risks and hazards involved in the sport of dance.
By initialing below, I acknowledge that Irish dancing is a voluntary recreational activity that, because of its physical nature, could result in injury. I certify that I do not have (or that my child/student does not have) any health condition that would limit ability to participate in these classes. I release Heartland Irish dancers and all its representatives from all claims on account of any injury which may be sustained by me (or my child/student) while attending any dance class, or event associated with HID. In signing this agreement and waiver, I acknowledge my responsibility in paying for tuition, required shoes and costumes, if any, and all costs involved in participating in this class. Additionally, my initials below certifies that I have read and agree to the school rules and the tuition, shoes and uniform policies listed in the above links.

Initials *

Family Photo Release

By initialing below, I understand that as a member of Heartland Irish Dancers, any pictures, videos, or other recorded media of me/my child(ren) may be used by HID for the promotion of HID activities and sponsored events.

Initials *

Online Class Agreement

By initialing below, I acknowledge that when participating in an online dance class or private lesson via Zoom or similar platforms, a parent or guardian is required to be present to maintain the safety of your dancer when the instructor is teaching remotely. The HID instructor may choose to record the session to share with absent students or those in attendance to review at a later date.

Initials *

Submit

YOUR CART