New Dancer Enrolment – Clárú 2022

1
Lynagh Enrolment

Lynagh 2021
Re-Enrolment Form

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

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)

2nd Child Details (if applicable)

2nd Child Name

2nd Child Date of Birth

3rd Child Details (if applicable)

3rd Child Name

3rd Child Date of Birth

Choice of Classes for 2022

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

Yes

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 – Beginners

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

*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...

Finalise your New Enrolment & Fee

To complete your enrolment, payment of $30 per family Enrolment Fee is required by 25/01/2022.

*I confirm...

I have paid the enrolment fee

*Payment Evidence Upload

Thank you for choosing to enrol with Lynagh Irish Dancing.

Submit your 2022 Enrolment

Parent / Guardian / 18yrs+ Dancer Signature >>

*Signature

Signed By

Lynagh 2021Re-Enrolment Form

Thank you for choosing to enrol with Lynagh Irish Dancing.

Parent / Guardian / 18yrs+ Dancer Signature >>

Lynagh 2021
Re-Enrolment Form