Rochez Academy of Irish Dance

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2010/2011 Registration Form

Please complete preferred classes for each dancer. The $15 registration fee can be brought to the first day of class, along with tuition. For more information, including class schedules, events, and tuition, download the registration information packet.

If you do not want your contact information to be shared with other parents, please note that in the box directed specifically to Eilis

All fields marked with an * are required.

Parent Name(s):*
Primary Address:*
City/State/Zip:*
E-mail Address(es):*

Home Phone:*
Cell Phone:		Text Messages OK? Yes No
Cell Phone:		Text Messages OK? Yes No
Dancer Information
Dancer 1 Name:*
Dancer 1 Level :*
Desired Class Day(s) :*	Tuesday Wednesday Thursday Saturday
Show Class:	Tuesday Wednesday

Dancer 2 Name:
Dancer 2 Level :
Desired Class Day(s) :	Tuesday Wednesday Thursday Saturday
Show Class:	Tuesday Wednesday

Dancer 3 Name:
Dancer 3 Level :
Desired Class Day(s) :	Tuesday Wednesday Thursday Saturday
Show Class:	Tuesday Wednesday

Specific questions or information for Eilis regarding your dancer:


For which Parent’s Guild events/projects would your family like to volunteer (choose as many as you like!)
Class Parent Christmas Party Show Committee Hooley (Fundraiser) Practice Feis	St. Patrick's Day Parade Memorial Day Parade Irish Festival Parent's Guild Board Costumes

By submitting this form, I am financially responsible for payment of this account, and agree to make all payments by the 7th of each month for that month. I understand that a $5 late fee will be applied to my account if I fail to make payments by that date. I and my child are aware that participating in dance is an activity with potential risks. I assume all risks associated with participation in any dance class, including, but not limited to, falls, contact with other persons, and any other reasonable risk conditions associated with dance. All such risks to my child/self are known and understood to me.
I agree to the above terms*

For additional information or questions, please contact:

Eilis Rochez-McKenna
(716) 568-1291
erochez@roadrunner.com

2010-2011 Class Schedule
Tuesdays David DeMarie (Clarence)
4:15-5:00 pm	Beginner
5:00-6:00 pm	Advanced Beginner
6:00-6:45 pm	Figures/Show class
6:45-7:45 pm	Novice
7:45-9:00 pm	Opens
Wednesdays Zion United Church of Christ
4:00-5:00 pm	Advanced Beginner
5:00-5:45 pm	Figures/Show Class
5:45-6:30 pm	Beginner
6:30-7:30 pm	Adult Class
Wednesdays David DeMarie (Elmwood Ave.)
7:00-8:00 pm	Novice/Opens Class
8:00-9:30 pm	Prelim/Champ Class
Thursdays Harlem Road Comm. Center
4:00-5:00 pm	Advanced Beginner
5:00-5:45 pm	Beginner
5:45-6:45 pm	Novice
6:45-8:00 pm	Opens
8:00-9:30 pm	Championship
Saturdays Harlem Road Comm. Center
9:00-9:45 am	Beginner
9:45-10:45 am	Advanced Beginner
10:45-11:30 am	Beginner