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   RRCA Dance Academy Registration


Student Information
Student's Name: Birthdate: Student ID:

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 Address:  City, State, Zip:  Student Email:


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 Home Phone #  Cell Phone #  





Guardian Information (to be completed if student is a minor)
 Guardian Name:  Relationship:  

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 Address:  City, State, Zip:  Guardian Email:


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 Home Phone #  Cell Phone #  Work Phone #




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Emergency Contact
 Primary Emergency Contact  Emergency Contact Phone #

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Medical Information
Hospital/Clinic Preference:
Physician Name:
Physician Phone #
Insurance Company:
Policy No.
Insurance Phone #
Allergies / Special Health Considerations:



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I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.   I (or my child) have no medical conditions that would prevent participation in the class(es) for which I (or my child) have been registered. I have completed the medical information for my child.   I give permission for my child to dance at the RRCA Dance Academy. I release RRCA Dance Academy and individuals from liability in case of accident during activities related to dance lessons and rehearsals, as long as normal safety procedures have been taken.   Students may have the opportunity to be photographed or video taped at various dance rehearsals and events. I authorize that these photos or videos may be included for RRCA publications or advertisements, including on our websites. I acknowledge that the RRCA may choose not to use the photos or videos at this time, but may do so at its own discretion at a later date.









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1. Tuition

Tuition schedule for the 2017-2018 school year:
Registration Fee: $25
Costume Deposit: $25 per costume (Due October 23)

Quarterly Rate: $_____________ (Due Aug. 21, 2017, Oct. 16, 2017, Jan. 8, 2018, Mar. 5, 2018)
Monthly Rate: $____________ (Due the 15th of each month)

2. Payment of Tuition

The undersigned agrees to pay tuition for the entire school year in the amount of $______________ (total tuition amount).

Parents shall select a payment plan for tuition from the following:

Option 1 – Single Payment Plan
I elect to pay the full tuition amount on or before August 28, 2017

Option 2 –Monthly or Quarterly
I elect to pay tuition through installments either quarterly or monthly beginning August 21, 2017 through March 5, 2018.

Option 3 – Custom Payments
I elect to pay tuition through my Custom Covenant Agreement, signed and dated on or before August 21, 2017 by Calley Duffey, Finance Director.

Payment of Tuition

The undersigned agrees to pay for tuition for the entire school year beginning September – April. Parents shall select a payment plan for tuition from the options set forth above. All tuition payment shall be made in accordance with the payment plan. Tuition is payable by check, money order, or cash. Payment by MasterCard, Visa, Discover or American Express is also acceptable.

Tuition Refunds
If the student(s) drops for a reason other than request by RRCA or mutual agreement during the school year, the tuition balance is expected unless the Executive Director approves a written request for tuition refund.

Late Payments
Any payments that are two weeks late will incur a $15 late fee.

Returned Checks
Any checks returned to RRCA due to non-sufficient funds will result in a $25 processing fee, in addition to any bank fees. If two checks are returned for insufficient funds, RRCA will no longer accept personal checks and the undersigned will be required to pay in cash, with a certified check from a local bank or maintain a credit card on file.

3. Financial Aid

Please request a form from the office prior to your registration appointment. Aid is given by financial need. Recipients are expected to offer Community Service Hours back to the school. Established hours are determined by Calley Duffey in the RRCA Office (734) 242-7722.

4. General Terms & Conditions

The terms and conditions of the RRCA enrollment and other policy information which may be provided to the student are hereby incorporated into this agreement by reference.
It is further understood that the student and the student’s parents/Guardians will abide by the policies and guidelines as documented in the RRCA Policies.
I/we understand that a place will be reserved for our student(s) only if this form and the deposit is submitted with this Agreement. I/we understand that acceptance of enrollment depends on the student’s successful completion of the current school year and on full payment of all tuition and fees for the current and/or prior school years.
If tuition costs are split between parents and/or other persons than separate tuition payment arrangements need to be made with the Finance Director and separate Tuition Contracts must be signed.
















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Class Price (per week) Price (per installment) Discount
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  Total (per Week):     $ {{GetFormClasses.data.sum( "price" )}}    
Payment Plan Options
Check one of the following options: (Pay in Full, Qrtly or MonthlyPymnts, Financial Aid) I give permission to automatically charge my credit/charge card for the following:
   Full Payment
   Qtrly Payments
    (Due  Aug. 21, 2017, Oct. 16, 2017,
     Jan. 8, 2018, Mar. 5, 2018)
   Monthly Payments
    (Due the 15th of each month)
   Financial Aid (Must meet with Calley Duffey)
   RRDA Tuition Payments
   RRDA Costume Fees
   RRB Participation Fees
   RRB Costume Fees


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Office Use Only
  Amount Due Amount Paid Date C/CH #
Registration Fee ($25)        
Installment I        
Installment II        
Installment III        
Installment IV        
Installment V        
Installment VI        
Installment VII        
Installment VIII        
Pre_Paid Full Year
(5% discount)


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2017-2018 RRDA Classes