Shovlin Academy of Irish Dance Registration: Sept 2019 - May 2020
• Classes begin Mon., September 9 and Wed., September 11
• Deadline September 1st
• Registration Form and Registration/Workshop Fee is required for each student
• Tuition due 1st day of class
• Dancers choosing 3 payment plan, 2nd & 3rd payments are due 1st classes in December and March

LOCATION: The Galleria of Mt. Lebanon, 1500 Washington Road, Mt. Lebanon, PA 15228


Registration Form 2019-2020
• All new dancers should enroll in Beginner Class.
• Enrollment in other classes by teacher invitation (current students see reg. email).
Payment Options
• Kindly submit payment and make checks payable to...
Shovlin Academy of Irish Dance
Galleria of Mt. Lebanon
1500 Washington Road
Pittsburgh, PA 15228
~ OR ~
Pay by credit card via
Registration/Workshop Fee - Due Sept 1st (non-refundable)
• Registration Form and Registration/Workshop Fee due by September 1st
• Required for all students
• Novice & up fee includes multi-day workshop with a visiting instructor (dates TBD)
Select applicable registration/workshop fee *
Tuition - Due 1st day of class
• See payment options noted above (by check or credit card)
Please indicate choice of tuition plan *
Please select your dancer's assigned level *
Class Registration
Please select assigned class time(s) *
Dancer Contact Information
Student's First Name *
Student's Last Name *
Student's Date of Birth *
Parent/Guardian Full Name #1 *
Parent/Guardian Full Name #2
Email Address (to receive all dance school info) *
Additional Email Address
Street Address *
City/State/Zip *
Home Phone Number
Mobile Phone Number *
Refund Policy
The Registration Fee is non-refundable. Only those classes that take place after the School is contacted about a student's withdrawal will be refunded (i.e., past-tense missed classes will not be refunded). Any discounts will no longer apply. Students withdrawing will be refunded money paid minus $20 per student per class for those classes that have taken place prior to the point of formal withdrawal. Payments by credit card may have PayPal fees deducted when refunding.
I am the parent/guardian of this student and hereby request that he/she be permitted to engage in Irish Dance class, utilizing facilities owned, operated and/or maintained by The Galleria of Mt. Lebanon-Pittsburgh, PA. I expressly acknowledge and recognize that participation in said dance activities creates a rise of injury to person or property and hereby expressly release, remise and forever discharge the class instructors and their assigns, The Shovlin Academy of Irish Dance, The Galleria of Mt. Lebanon-Pittsburgh, PA, and each of their officers, agents and employees from any liability for any and all claims, suits or causes of action arising from injuries to the person or property of the student named above as a result of his/her use of recreational facilities owned, operated and/or maintained by The Galleria of Mt. Lebanon-Pittsburgh, PA.

My submission of this registration confirms that this student does not have any pre-existing medical condition that would prohibit or limit their full participation in his/her class curriculum. Should my child/this student have a pre-existing medical condition that would limit or prohibit his/her full participation in his/her class curriculum, I will provide written medical clearance from his/her primary care physician prior to admittance as a student of the Shovlin Academy of Irish Dance.
I have read this release and intend to be legally bound by submission of this registration. *
Survey Questions
• Before scheduling extra classes, we'd like feedback on your dancer's interests
• These questions apply to all levels
• Competition (feis) schedule
• Grade Exams
My dancer is interested in additional classes for (check all that apply) *
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