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New Dancer Enrolment – Clárú 2021

Please complete our secure enrolment form below Once received, one of our teachers will be in touch to confirm your details and your class preferences. If you prefer to enrol offline, please email us and we will arrange.

Lynagh Irish Dancing

New Dancer Enrolment Form

Dancer's First Name: *

Dancer's Family Name: *

Date of Birth: *

Home *

Address

Suburb

Postcode

Mobile (if dancer is over 18yrs)

Email (if dancer is over 18yrs)

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Parents / Guardian Details

Mother's / Guardian Name: *

Phone *

Email *

Father's Name: *

Phone *

Email *

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2nd Child Details (if applicable)

2nd Child's Name

Date of Birth:

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3rd Child Details (if applicable)

3rd Child's Name

Date of Birth:

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Classes

Has your child danced in the past twelve months in another Irish Dance Class ? *

Yes

No

If Yes, please list previous Teacher’s Name....

Please tick the classes that you wish to attend. You may tick a choice of 1, 2 or 3 Classes per week. *

Tuesday class at Belmont Scouts, 84 Wright Street, Carindale – Primary Only

Tuesday class at Wynnum Scouts, 20 Bridge Street, Wynnum– Beginners/Primary

Thursday class at Belmont Scouts, 84 Wright Street, Carindale – Beginners/Primary

Saturday class at Belmont Scouts, 84 Wright Street, Carindale – Beginners/Primary

Your enrolment and your choice of class/es will be confirmed after this Registration Form has been received.

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Medical Consent

Family Name *

In the case of a Medical Emergency occurring with you/your child at our dance classes and the venue at the time of use, every effort would be made to contact Parent/Next of Kin from the information that you have provided us. If this fails what would be your preferred option. Please choose ONE option below...

OPTION 1 - Contact my Doctor

OR OPTION 2 - Contact with the Ambulance Service for transportation to the nearest Hospital or nearest Emergency Department. *

Yes

No

OR OPTION 3 - Contact my nearest relative or friend *

Yes, complete the details below

No

Relative / Friends Name

Phone Number

Address

Suburb

Postcode

Is there any Medical condition which your child / children may have, of which we should be aware in relation to them attending our Dance Classes. Please provide details –

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How did you hear about Lynagh Irish Dancing ?

Were you recommended to us by someone? If so please list their name below...

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Finalise Enrolment & Fee

To complete your Enrolment, payment of $25 per family Enrolment Fee is required.

Our Bank Details are as follows -

Account Name: B Mackness

Bank: St George Bank

BSB No: 114 879

Account No: 484 600 271

I confirm I have paid the enrolment fee

Payment Evidence Upload *

Choose File...

Max File Size: 20MB · Allowed File Types: jpg,png,pdf

Thank you for choosing to enrol with Lynagh Irish Dancing.

Parent / Guardian / 18yrs+ Dancer Signature *

LYNAGH IRISH DANCING

https://www.lynaghirishdancing.com

Form Submitted Successfully!

We will contact you as soon as possible.

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Lynagh Irish Dancing