Registration Form

Please fill out the form below to register for classes

Student Information

First Name Last Name Birthday

Guardian Information (For Under 18yrs.)

Guardian's Name Relationship Phone Number Email

Address

Contact Information

Phone Number Email

Address

Emergency Contact Information

Emergency Contact Name Emergency Contact Relationship Phone Number

Address same as above Address

Registration Details Irish Step Dance

Prior Dance History Yes No

What school were you last a part of? When was the last time you had class?

Have all fees and payments been made to your prior school? Yes No

Were you a competitive dancer? Yes No

What organization did you compete through? What level did you compete at?

Select the class you are interested in

Would you like to take classes for recreation or competition? Recreation Competitive

Irish Music Classes

Do you have any music history? Yes No

What Instruments are you interested in learning?

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Would you need loaner instruments? Yes No

Would you prefer a group class or individual class? Group Individual

Irish Fine Arts

Optionally, provide details about your interest in Irish Fine Arts:

If there are any allergies/health conditions we should be aware of, please list them below: How did you hear of us? Promotional Code

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