DANCER REGISTRATION PACKET

2024-2025
Welcome to Mumford Academy of Irish Dance!

Dear Dancer,

I am thrilled to extend a heartfelt welcome to you as you embark on this exciting journey
with us at Mumford Academy of Irish Dance. Your passion for dance has led you to our
doorstep, and I couldn't be more delighted to have you join our vibrant community of
dancers.

At Mumford Academy, we cherish the artistry, discipline, and camaraderie that dance
fosters. As you step into our studio, know that you are not just a student, but a valued
member of our dance family. Here, you'll find a supportive environment where you can
grow, learn, and express yourself through the graceful and athletic movements of Irish
dance.

Your presence enriches our dance community, and we're eager to witness your talent
flourish and your spirit shine. Whether you're a beginner or seasoned dancer, know that
you are in a place where your dreams can take flight.

Once again, welcome to Mumford Academy of Irish Dance! Let's dance, learn, and
create unforgettable memories together.

With warm regards,

Madeline Mumford
Madeline Mumford | Founder & Head Coach

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 Dancer Registration
Dancer(s) Information:

Name: _______________________________ Date of Birth: _______________________

Current Grade Level:_______________________

Mumford Academy Classes & Location:_____________________________________________

Parent/Guardian Information (if Dancer(s) is under 18):

Name: _______________________________ Relationship to Dancer(s): _______________

Primary Email Address: _______________________________

Secondary Email Address: _______________________________

Contact Information:
Home Address

Address: ___________________________________________________________

City: _______________________________ State: ______ Zip Code: ______________

Phone Number: ________________________

Dancer(s) Email Address: ____________________________________

For dancers who’d like to receive messages from Mumford Academy of Irish Dance. Parent /
Guardian primary email will be CC'd on all correspondence.

Emergency Contact(s):

Name: _______________________________ Relationship to Dancer(s): _______________

Phone Number: ________________________

Dancer(s) Medical Information:

Kindly provide details of any medical conditions, allergies, or other pertinent information that you
believe we should be aware of. If there are no such details to report, simply indicate 'N/A' or
leave the section blank.

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Payment Method:
This information will be kept strictly for our internal records. Please note that payment methods
available may be subject to change.
In Studio Payments: Dancer / Guardian will pay tuition via cash or check.
Venmo-ed Payments: Dancer / Guardian will submit tuition via Venmo:
@mumfordacademy.
Other: Please discuss with a Mumford Academy coach regarding other forms of
payment.

Referral Information:
Social Media
Online Search
Mumford Academy Irish Dancer
N/A
Please include any more information regarding referral. If you selected ‘Mumford Academy Irish
Dancer,’ please include the dancer’s name below:

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 Release of Liability
I/we understand that participation in dance classes and activities could potentially involve some
personal injury. Despite precautions, accidents and injuries may occur. Through signing this
release form, I/we (the dancer(s) and parent/guardians) assume all risks related to the use of
any and all spaces used by the Mumford Academy of Irish Dance (MAID). I/we agree to release
and hold harmless MAID, including its owners, teachers, dancers, staff members, and facilities
used by MAID from any cause of action, claims, or demands now and in the future. I/we will not
hold MAID liable for any personal injury, including serious injury or death, or any personal
property damage or loss, which may occur on the premises before, during, or after classes.
Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our
behavior in addition to any damage I/we may cause to the facilities utilized by MAID.

In consideration of being allowed to participate on behalf of the Mumford Academy of Irish

Dance, Irish Dance program, and related events and activities, the undersigned acknowledges,
appreciates, and agrees that:

1. Participation includes possible exposure to and illness from infectious diseases including
but not limited to MRSA, influenza, and COVID-19. While rules and personal discipline
may reduce this risk, the risk of serious illness and death does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown,
EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and
assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for
participation as regards protection against infectious diseases. If, however, I observe any
unusual or significant hazard during my presence or participation, I will remove myself
from participation and bring such to the attention of the nearest official immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of
kin, HEREBY RELEASE AND HOLD HARMLESS the Mumford Academy of Irish Dance,
their teachers, officials, agents, and/or employees, other participants, sponsoring
agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used
to conduct the event with respect to any and ALL ILLNESS, disability, death, or loss or
damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF
RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

Dancer(s) Information:

Name: _______________________________ Date of Birth: _______________________

Address: __________________________________________________________

Phone Number: ________________________ Email: _______________________________

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Parent/Guardian Information (if Dancer(s) is under 18):

Name: _______________________________ Relationship to Dancer(s): _______________

Phone Number: ________________________ Email: _______________________________

Emergency Contact Information:

Name: _______________________________ Relationship to Dancer(s): _______________

Phone Number: ________________________

Agreement to Terms:

I/we have read and understand the above release of liability, waiver for communicable diseases,
and acknowledgment of risk. I/we understand that by signing this form, I/we are giving up legal
rights and remedies that may be available to me and/or my child.

Dancer(s) Signature: ___________________________ Date: ___________

Parent/Guardian's Signature (if Dancer(s) is under 18): ___________________________

Date: ___________

Contact Information:

For any questions or concerns, please contact:

Mumford Academy of Irish Dance

Phone: www.mumfordacademyofirishdance.weebly.com
Email: mumfordacademyofirishdance@gmail.com

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 Media Release Form
I grant permission for the dancer(s) named on this form to be included in photographs and/or
videos of activities with the Mumford Academy of Irish Dance. I understand that images may
appear in Mumford Academy social media, websites, publications, Mumford Academy
advertisements, and printed materials. I understand that I am not eligible for compensation for
or ownership rights to photos used by the Mumford Academy of Irish Dance.

I also grant permission for these materials to be shared with and used by collaborating
organizations or companies, provided the usage aligns with the promotional and lawful
purposes stated above.

Participant Information:

Dancer (s) Name: _______________________________________ Age: _______ (if under 18)

Parent/Guardian Name (if under 18): __________________________________________

Address: __________________________________________

Phone Number: __________________________ Email: _______________________________

Agreement:

By signing below, I acknowledge that I have read and understood the terms of this media
release form. I affirm that I am of legal age to grant consent for myself or as a parent/guardian of
the minor named above.

Dancer(s) Signature: ___________________________________ Date: _______________

Parent/Guardian's Signature (if under 18): ________________________ Date: ____________

Contact Information:

For any questions or concerns, please contact:

Mumford Academy of Irish Dance

Phone: www.mumfordacademyofirishdance.weebly.com
Email: mumfordacademyofirishdance@gmail.com

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 Policy Recognition & Agreement
TUITION

Our tuition policy operates on a pay-per-class attendance basis. Enrollment into Mumford
Academy remains open throughout the year, ensuring flexibility for aspiring dancers. Tuition cost
will vary depending on length of class time. The tuition cost-per-class is outlined below:

Length of Class Class Cost

Time

30 minutes $15

45 minutes $20

60 minutes $25

As part of our offerings, all enrolled dancers have the opportunity to participate in the Mumford
Academy Summer Showcase. Please note that participation in the showcase will require
payment of additional fees.

Additionally, dancers will be encouraged to take part in St. Patrick’s Day shows during the
March season. Mumford Academy does not charge any dancer fees for participating in these
shows. It’s worth noting that while participation in these events is encouraged, it is not
mandatory, allowing dancers to choose their level of involvement based on personal preference
and schedule availability.

At Mumford Academy, we firmly believe in providing equal opportunities for all dancers to
access quality dance instruction. If tuition fees pose a challenge for any individual, we
encourage them to reach out via the contact information provided below. We are committed to
working with families to find suitable arrangements that ensure every dancer can benefit from
our programs.

PAYMENT METHODS

Payments can be made online via Venmo @mumfordacademy, or with cash or cheque payable
to Mumford Academy of Irish Dance. If a family emergency or extenuating circumstances cause
a payment delay, please contact us to discuss payment options.

REFUNDS

Mumford Academy reserves the right to cancel any class that does not meet our registration
minimums. Registered dancers will be provided with an alternative class or a refund if no class
time is available.

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CLASS POLICIES

Dancer Absence At Mumford Academy, we operate under the principle that a dancer should
not be charged for a class they are unable to attend. If a class fee has been paid in advance
and the dancer is absent, the credit for that class may be applied to the following class the
dancer attends. Alternatively, a one-time reimbursement may be issued for the missed class.
This policy ensures fairness and flexibility for our dancers.

Cancellations If a class is canceled, an email will be sent to all registered dancers at the email
address provided at registration. Cancellation notices may also be posted on our social media
pages and for weather-related cancellations on the Jacksonville Broadcasters Association.

Dancer Expectations Dancers at Mumford Academy are expected to adhere to and uphold the
standards outlined in the Mumford Academy of Irish Dance Handbook. Dancers are encouraged
to actively contribute to a positive atmosphere within Mumford Academy, fostering a supportive
and collaborative environment for all members.

Agreement:

I have read and agree to all Mumford Academy of Irish Dance Policies
I have read and agree to all of the information outlayed in the Mumford Academy of Irish
Dance Handbook (separately attached)

By signing below, I acknowledge that I have read and understood the terms of this Policy
Recognition & Agreement form. I affirm that I am of legal age to grant consent for myself or as a
parent/guardian of the minor named above.

Dancer(s) Signature: ___________________________________ Date: _______________

Parent/Guardian's Signature (if under 18): ________________________ Date: ____________

Contact Information:

For any questions or concerns, please contact:

Mumford Academy of Irish Dance

Phone: www.mumfordacademyofirishdance.weebly.com
Email: mumfordacademyofirishdance@gmail.com

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 Registration Confirmation & Completion
Registration Confirmation:

By signing below, I acknowledge that I have read, understood, and agree to the terms of all
Registration documents. I affirm that I am of legal age to grant consent for myself or as a
parent/guardian of the aforementioned minor named above.

Parent/Guardian's Signature (if under 18): ________________________ Date: ____________

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Thank you for your Registration!

Dear Dancer,

Thank you for choosing Mumford Academy of Irish Dance! We are truly grateful for your
trust and commitment to our program. Welcome to our dance family, and we look
forward to sharing this incredible journey with you!

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