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. × Dismiss alert Lynagh Irish DancingNew 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) ----------------------------------------------------------------------------------------------------------------------------------------------------- Parents / Guardian Details Mother's / Guardian Name: * Phone * Email * Father's Name: * Phone * Email * ----------------------------------------------------------------------------------------------------------------------------------------------------- 2nd Child Details (if applicable) 2nd Child's Name Date of Birth: ----------------------------------------------------------------------------------------------------------------------------------------------------- 3rd Child Details (if applicable) 3rd Child's Name Date of Birth: ----------------------------------------------------------------------------------------------------------------------------------------------------- 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. ----------------------------------------------------------------------------------------------------------------------------------------------------- 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 – ----------------------------------------------------------------------------------------------------------------------------------------------------- How did you hear about Lynagh Irish Dancing ? Facebook Friend Website / Google Event / Performance / Show Newspaper / Flyer Other Were you recommended to us by someone? If so please list their name below... ----------------------------------------------------------------------------------------------------------------------------------------------------- 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 MacknessBank: St George BankBSB No: 114 879Account 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 * Submit LYNAGH IRISH DANCING https://www.lynaghirishdancing.com Form Submitted Successfully!We will contact you as soon as possible.