2023-2024 Scoil Rince Daryl Rose Registration

Dancer Information

**How did you hear about us?**

Student's Name*

First NameLast Name

Student's Name (For siblings)

First NameLast Name

Birth Date*

MonthDayYear

Birth Date

MonthDayYear

Preferred Pronouns

Parent/Guardian Information

Name*

First NameLast Name

Name

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail (Email will be added to our MailChimp communication list)*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship

Phone Number*

Area CodePhone Number

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is the student prescribed an inhaler? If yes, please explain any instructions.*

Photo Release and Authorization

Please be advised that Scoil Rince Daryl Rose takes photographs and video of our students for promotional purposes, which may be displayed on our website and social media. Please speak to our instructor if you do not wish to have photos or videos of your child used.

Acknowledgement

Scoil Rince Daryl Rose is registered with An Coimisiun Le Rinci Gaelacha (CLRG), the largest certifying body for Irish dancing teachers worldwide. Per CLRG, a child may only receive lessons from one teacher registered with the organization at a time. By signing your child up for the class, you agree to abide by this policy.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

School Handbook*

I have read and understood the School Handbook: http://srdririshdance.com/school-handbook/ Password: darylrose

PayPal Transaction ID **MUST BE SUBMITTED IN ORDER FOR REGISTRATION TO BE COMPLETE***

2024-2025 Registration + 1st month tuition for 1 dancer=$75. Registration + 1st month tuition for 2 dancers=$135. Send via PayPal to info@srdririshdance.com

2024-2025 Scoil Rince Daryl Rose Registration