Date_______________ Name (Student) ______________________________________________________DOB___________________

Name (Parent) ________________________________________________________________________US Shoe size_______________

Address_______________________________________________________ City_______________________ Zip __________________

Home Phone ___________________________ Cell Phone ______________________Email___________________________________

Emergency Contact_____________________________________________________________________________________________   I hereby apply for myself/my child to become a student of The Rhythm of Ireland. I/we have received the Student/Parent Handbook and agree to read and follow all of the policies and procedures of the school. (initial) ________I understand that tuition is due on the first day of each month in advance and on the 16^th day a late fee will be invoiced on any outstanding balances owed. (initial)________ Registration and tuition fees are non-refundable. (initial)___________ I understand there is a one month minimum on any class signed up for. If classes are missed during any month I am still responsible for the entire month unless cancelled in writing 15 days prior to non-participation in class. (initial)_________ Missed classes due to illness or emergency are made up in another class at any time during the year. (initial)________

Tuition is based on 4 weeks X 12 months = 48 classes per year. Some months have 5 weeks & some months have 3 weeks. During vacation months there may only be 2 weeks. Every student will always received the scheduled 48 classes per year.