Jigs for Kids 2025 Detailed Registration Form

This is a week-long, half-day camp celebrating Irish culture and dance via dance, storytelling, music, arts, and crafts! This is an excellent introduction to Irish soft and hard shoe dancing at the longest running Irish dance school in Oregon. This camp is open to students completely new to Irish dance and to beginner Yeates Academy students who have not started hard shoe. All campers get a Yeates t-shirt as part of their registration

Camp cost is $250, due no later than the first day of camp, July 14th. Pre-payment is allowed

Camp cost can be paid in cash, a check addressed to Meaghan Feeback, or on VenMo @Meaghan-Feeback

Submit one form per dancer

Please submit any additional questions to meaghan.feeback@gmail.com

12 participant maximum

Dancer Information

Child's Name

First NameLast Name

Child's Age at time of Camp

Parent/Guardian Information

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

E-mail

example@example.com

Emergency Information- who we should contact day of

Emergency Contact's Name

First NameLast Name

Emergency Contact's Phone Number

Please include any injuries, allergies, etc

How did you hear about our camp?

T-Shirt

Please select a size for your dancer

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Yeates Academy of Irish Dance during the selected camp. In exchange for the acceptance of said child’s candidacy by The Yeates Academy of Irish Dance, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Yeates Academy of Irish Dance and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against The Yeates Academy of Irish Dance including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including dance.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Yeates Academy of Irish Dance and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Signature

Jigs for Kids™ Salem, OR

Medical Information