Registration Form
Child’s Name
First Name
Last Name
Child’s Age
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Please select the group you wish to register for
Beginner / New Starter
Grades
Championship
Parent’s / Guardian’s Name
First Name
Last Name
Parent’s / Guardian’s Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency contact Name
First Name
Last Name
Emergency contact relationship to the child
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please outline any medical conditions or medications the teachers need to be aware of:
I the above mentioned parent / guardian (select Give Consent or Do Not Give Consent) to CALLANAN MACLOONE O’MEARA to use still images (photos) or video clips / footage so Marketing, PR and Social Media purposes related to the dance school. This may include posters, Facebook, Instagram etc.
Give Consent
Do not give consent
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: