Director

O'Shea Irish Dance Registration 2006-2007


* required field

*Date:

*Student's Name:

Gender: (M) (F)
School:
Grade Level:
Date of Birth:
*Age:

*Parent/Guardian's Names:

*Street Address:
*City:
*State:
*Zip:

*Home Telephone:
Cell Phone:
*Email:

Emergency Contact Name & Relation:
Emergency Contact Home Telephone:
Emergency Contact Cell Phone:

Please list other physical activities you participate in:


RETURNING STUDENTS:
Please list most recent class level:

O'Shea Irish Dance, LLC reserves the right to cancel a class if enrollment is less than 5 students per class.

For reference, here are our Policies and Procedures (PDF) and Release Agreement (PDF).



Copyright © 2008 O'Shea Irish Dance