Dancer Name *
Dancer Name
Date of Birth *
Date of Birth
CONTACT INFORMATION
Home Address *
Home Address
Phone Number *
Phone Number
GUARDIAN INFORMATION
Guardian Name
Guardian Name
Required for dancers under the age of 18.
In case of an emergency, listed guardian will be notified first. Use this space to include additional guardian or emergency contact information.
DANCER INFORMATION
Please note any medical conditions, allergies, and/or other pertinent medical information you would like us to know about your dancer.
REQUIRED POLICIES AND AGREEMENTS
KSID Policy Agreement *
I have read all KSID policies as stated on the KSID policy page.
KSID Payment Policies *
I have read and agree to all KSID payment policies as stated on the KSID policy page.
KSID Photo Release *
I hereby grant permission for the dancer named on this form to be included in photographs and/or videos of activities with The Kelly School of Irish Dance, LLC. I understand that images may appear in KSID social media, websites, newspaper or other such publications, KSID advertisements, printed material, and recital DVDs. I agree that I am to receive no compensation for photos used by KSID. I have no ownership rights to the photography.
Release of Liability *
I/we realize that participation in dance classes and activities could involve some possible personal injury. Despite precautions, accidents and injuries may occur. By signing this release form, I/we (the dancer(s) and parent/guardians) assume all risks related to the use of any and all spaces used by The Kelly School of Irish Dance, LLC, (KSID). I/we agree to release and hold harmless KSID, including its owners, teachers, dancers, staff members, and facilities used by both entities from any cause of action, claims, or demands now and in the future. I/we will not hold KSID liable for any personal injury or any personal property damage or loss, which may occur on the premises before, during, or after classes. Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by KSID.
I declare the dancer named on this form to be in good health and give my permission for him/her to participate in any & all activities with The Kelly School of Irish Dance. In typing my name below I acknowledge I have read, understood, and I agree to all of the above.
PAYMENT INFORMATION
NEW FOR 2017: To ensure tuition payments are made in a timely manner, any payment outstanding past two weeks of the due date will be charged to the credit card on file provided at time of registration. Families must keep a valid credit card on file at all times. No charges will be made at this time.
Credit Authorization
Registration and tuition payments are accepted via this website, or collected at the studio via cash, check, or credit card. To ensure tuition payments are made in a timely manner, any payment not received within two weeks of the due date will be charged to the credit card on file. Late payments processed by KSID are subject to a $20 late fee.
In-Studio Purchases
REFERRAL