New Dancer Enrolment – Clárú – Lynagh Irish Dancing

Please complete our secure enrolment form below Once received, one of our teachers will be in touch.

Please note all items marked with an asterisk * are required.

Please not all items marked with an asterisk * are required.

New Dancer's Details

*Dancer's First Name

*Dancer's Last Name

*Dancer Date of Birth

*Dancer Home Address - Line 1

*Dancer Home Address - Line 2

2nd Dancer / Child Details (if applicable)

2nd Child Name

2nd Child Date of Birth

3rd Dancer / Child Details (if applicable)

3rd Child Name

3rd Child Date of Birth

Parents / Guardian & Contact Details

*Mother's / Guardian Name

*Mother / Guardian Phone Number

*Mother / Guardian Email

*Father's Name

*Father Phone Number

*Father Email

Dancer Contact Details (ONLY required if Dancer is over 18 years of age)

Dancer's Mobile (if dancer is over 18yrs)

Dancer's Email (if dancer is over 18yrs)

Previous Experience

Has your child learnt dancing in the past twelve months in another Irish Dance Class ?

Yes

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

Medical Consent

*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...

Medical Consent OPTION 1 - Contact my Doctor

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

Yes

*OR OPTION 3 - Contact my nearest relative or friend

Yes (complete details below)

Relative's / Friend Name

Relative's Phone Number

Relative's Address

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 us?

*Please Select

Were you recommended to us by someone? If so please list their name below (For survey purposes only)

Submit your Enrolment

Parent / Guardian / 18yrs+ Dancer Signature >>

*Signature

Signed By