Specialty Registration

I want to register for: *Toddler GrooverBallroom

Participant Information

First Name

Last Name

Birthday

Gender

First Name

Last Name

Birthday

Gender

Any Allergies or Medications or Special Considerations?

Yes

Allergies or Medications, Special Considerations

Contact Information

First Name

Last Name

Relation

Email AddressAll important notices and updates will be sent via this email provided.

Cell Phone

First Name

Last Name

Relation

Email AddressAll important notices and updates will be sent via this email provided.

Cell Phone

Participant Address

Address

City

ZIP / Postal Code

Home Phone

Tax Receipt

Tax AddressSame as AboveDifferent Address

Name

Street Address

City

State/Province

ZIP / Postal Code

Country

Session Selection

Toddler Groovers

Ballroom

Registration Terms & Conditions

I agree to pay my fees in full via credit or debit card below.
I understand there will be no refunds after December 1st, 2023.
I agree that if my account is not up to date by March 25, 2023 interest charges will apply. After a third attempt, a collection agency will be contacted.
I agree that the email address(es) I provided at registration is/are to be used for communication reasons. It is the recipients responsibility to make sure all communications are read - RDA is not responsible for emails going to SPAM or PROMOTIONS. Please check these folders BEFORE inquiring about a missed communication. Add us to your contacts/safe senders lists.
I agree to inform a studio director or office manager if participant(s) withdrawals from Rivertown Dance Academy, via email or written letter.
I give consent that the name of dancer, photos, and video footage taken during participation at the Rivertown Dance Academy may be used for promotional advertising including use in newspaper articles and social media.

1. If you do not agree to the above photo consent please indicate on the registration page under “photo consent.”

I agree should I have any complaints or concerns regarding Rivertown Dance Academy I will contact a studio director (Catherine Cristofaro, Laura Dufour) or the office manager.
Only payments made by December 31st, 2023 will be reflected on your 2023 tax receipts from Rivertown Dance Academy Inc. Each receipt will be emailed to you and is considered legitimate for tax receipt purposes. Please keep them for your records.

Please contact us if you have any questions.

Terms and Conditions *Yes, I agree with the Terms and Conditions and our Privacy Policy including Terms of Service.

Photo Consent *YesNoas noted in the Terms & Conditions

Receiving Email Communications *

E-Signature *This field will serve as your electronic signature as final agreement to all terms and conditions unless otherwise noted.

Subtotal

$

Taxes

$

Total

$