Summer 2020 Registration
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Please refer to our summer 2020 class list for class descriptions and prices. If you have any questions, please feel free to contact us via email(pmadore@richlandacademy.com) or phone(419-522-8224).
Please note that our class sizes have been limited to no more 9 students and 1 instructor. If the class is full you will be contacted and placed on a waiting list.
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Student Name *
Gender
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Mother/Guardian Name (If you are an adult student, please put "Adult Student") *
Mother/Guardian/ Adult Student Cell # *
Mother/Guardian Place of Employment
Father/Guardian/ Spouse Name *
Father/Guardian/Spouse Cell # *
Father/Guardian Place of Employment
Street Address *
City *
Zip *
County *
Student DOB *
MM
/
DD
/
YYYY
Age *
School
Grade (entering in fall 2020)
Please list all known allergies, medical conditions, and medications *
Email *
I agree to receive emailed monthly statements (this does not auto-enroll in auto-pay). *
I understand that I will be charged a $3/month payment plan fee unless enrolled in auto-pay or paid in full. *
8 Week Dance Classes
6 Week Dance Classes
4 Week Dance Classes
Dance Camps
Music Camps and Classes
Senior Classes
Art Camps and Classes with Dana Reed
Kenpo with Jason Farnsworth (Start week 6/15/20)
Private Music Lessons
Other Private Lessons
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