RHID Summer 2020
Please fill out form to register your dancer for the summer
Email *
Dancer's First Name *
Dancer's Last Name *
Gender *
Date of Birth *
Please let us know how you plan to participate: attend in person or Online??? *
Please check off the policies as you review them.
Please select the SUMMER class option for your child based on their age/experience. *
Summer 2020 - Current Members - The intensive will cover New Soft Shoe Steps, The 5 Week will cover Hard Shoe. Not attending summer sessions may result in not progressing with the dancer's class. The sibling discount DOES apply for summer programs.
Email address - Please type carefully *
Please enter an email address to receive important information.
Email address - Secondary, or Student email *
Parent Contact Information
If you are an adult applying for dance classes, feel free to skip parts of this section, as long as you enter at least one phone number and a current mailing address.
Mother's Full Name *
Father's Full Name *
Primary Phone Number *
Please use the following format: (000) 000-0000
Mother's Work or Cell *
Please use the following format: (000) 000-0000
Father's Work or Cell *
Please use the following format: (000) 000-0000
Full Mailing Address *
Example: 123 Market Street, Camp Hill, PA 17011
Medical and Insurance Information
Submitting medical information is ONLY required for all dancers ATTENDING AT THE STUDIO. If your dancer will be participating at home, please type NA in all the boxes pertaining to insurance.
Name of Insurance Company *
Company Address *
Name of Policyholder *
Name of Secondary Policyholder
Employer *
Group Number *
Identification Number *
Phone Number for pre-authorization *
If required by your insurance plan
Allergies *
Please list any food or prescription drug allergies.
Medications *
Please list any medications that the student is currently taking.
Conditions *
Please list any special physical or psychological conditions, past or present, of which RHID should be aware.
Disclosure *
In the event I cannot be reached, I hereby give my permission to the management, faculty, staff and chaperones of the Rebel Heart Irish Dancers to authorize any emergency medical care that may be required by the above student during participation in classes, performances, or any related RHID events. This authorization extends throughout the current academic year or until the student is no longer enrolled at RHID, whichever comes first. I understand that I am responsible for any and all charges as a result of such care or medical treatment.
Policy Overview
Please read carefully. This information and additional rules and policies are also available in our student handbook.
Tuition Policies *
Please check off each policy as you have read it. Each box must be checked in order to complete your registration.
Dress Code *
To maintain the professional attitude of RHID, students should respect the dress code. All dancers attending VIRTUALLY MUST HAVE A WHITE SOCK ON THE RIGHT FOOT, and a BLACK SOCK on the Left foot.
Liability and Publicity Release
Please read carefully.
Liability Disclosure *
I am aware that dance training and the athletic exercises associated with it place unusual stress on the body and carry the risk of physical injury. On behalf of my child and myself (and if I am no longer a minor, on my own behalf), I assume the risk and agree that the Rebel Heart Irish Dancers shall not be liable in any way for injuries sustained during attendance at the studio or any of its related functions. I also understand that good dance training involves touching and adjustment of the student’s body by the instructor.
Publicity Release *
I hereby authorize the Rebel Heart Irish Dancers to record the student’s picture and voice on photographs, films, and tapes, to edit these recordings at its discretion, and to incorporate these recordings into movie and sound films on tapes, radio, or television broadcast programs. I also give my permission for RHID to use and license others to use these materials in any manner or media whatsoever. RHID is permitted to use these materials for publicity, advertising and sales promotion and to use the student’s name, likeness and voice and biographic or other information in connection with them. I acknowledge that no promises of compensation were made by RHID for such use.
Digital Signature *
By typing my initials below, I am stating that I have read and understand the above policies.
You're almost done!
NEW MEBERS ONLY: How did you hear about us?
If you were referred by a friend please TELL US WHO! We offer referral discounts to our members. If you heard about us through our Facebook /Website, or have previously danced with us, put "Rebel" in the box to receive the discount (only applicable if payment is received by June 15th).
Have you filled out everything carefully? *
Make sure the information you've entered is correct!
Master Andrew talks about The benefits of Dance for BOYS!
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