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Fall 2020 Online Registration
WARNING/PLEASE READ:
-Do not hit back on your browser, use the buttons at the bottom of the form if you need to return to a previous page on the form.

-If you are registering multiple students, you will need to complete a registration form for each student. We apologize for the inconvenience.

-Please refer to our class list for class descriptions and prices. If you have any questions, please feel free to contact us via email (frontdesk@richlandacademy.com), phone (419-522-8224), or on any of our socials.

-ONLY submit this form ONCE per student

-You will receive a confirmation email within 48-72 hours of registering
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Student Name *
Is this a new, returning, or current student?
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Gender
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Parent/Guardian 1 Name (If you are an adult student, please put "Adult Student") *
Parent/Guardian 1 /Adult Student Cell # *
Parent/Guardian 1 Place of Employment
Parent/Guardian 2 Name *
Parent/Guardian 2 Cell # *
Parent/Guardian 2 Place of Employment
Street Address *
City *
Zip *
County *
Student DOB *
MM
/
DD
/
YYYY
Age *
School
Grade (entering)
Please list all known allergies, medical conditions, and medications *
Email *
I agree to receive emailed monthly statements (this does not auto-enroll in auto-pay). *
I understand that I will be charged a $5/month payment plan fee and/or enrolled in auto-pay with a 2% convenience fee and/or will pay in full upon arrival. *
Dance Master Classes/Workshops
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Private Music Lessons
Other Private Lessons
Music Classes
Martial Arts/Kenpo
60+ Classes
Dance Classes Age 3
Dance Classes Age 4
Dance Classes Age 5
Dance Classes Age 6
Dance Classes Age 7
Dance Classes Age 8
Dance Classes Age 9
Dance Classes Age 10-11
Dance Classes Age 11-13
Dance Classes Age 13+
Dance Classes Teens/Adults
COMPANY ONLY Dance Classes (radKidz, radKidz 2, rade jr., rade)
Theatre & Personal Development
Visual Arts
Custom Classes - Let us know what YOU want to take!
Do you have any questions that we can answer?
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