REGISTRATION FORM

REGISTRATION FORM

Together We Dance
TUESDAY CLASSES

Mini Movers (3.5-6yrs) @ 4-5pmJunior Contemporary Dance (7-9yrs) @ 5-6pmSenior Contemporary Dance (10-16yrs) @ 6-7pm
WEDNESDAY CLASSES

Mini Movers (3.5-6yrs) @ 4-5pmSenior AcroDance (9-16yrs) @ 5-6pm
THURSDAY CLASSES

Junior AcroDance (6-8yrs) @ 5-6pmBreakdance Juniors (6-9yrs) @ 6-7pmBreakdance Seniors (10-16yrs) @ 7-8pm
Child's Full Name *

First NameLast Name
Child’s Age *
Date of Birth*
Address*

Street Address

Street Address Line 2

City
Contact Number*
Please enter a valid phone number.
Medical / Allergy Information*
I AGREE FOR MY CHILD’S PHOTOGRAPH, VIDEO FOOTAGE OR AUDIO TO BE TAKEN BY TOGETHER WE DANCE FOR USE IN MARKETING, PR AND PUBLICATIONS*

YesNo
Emergency Contact 1 (name & number)*
Emergency Contact 2 (name & number) *
Please tick YES to confirm your booking (no payment required at this stage)*

YESNo, I don’t want to book
View our term dates & fees info here: https://togetherwedancewexford.com/page/fees-and-term-info
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