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An Daire Academy Class Enrollment
Class Registration & Student Information Form
Email address *
Student Last name, First Name *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Parents Name(s) - First & Last *
Your answer
Email *
Your answer
Phone # *
Your answer
Mailing Address (Street, City, State, Zip) *
Your answer
Known Allergies / Health Conditions:
Your answer
Emergency Contact Info: *
Your answer
Phone # (Emergency Contact) *
Your answer
How did you hear about us?
1st Class Option *
2nd Class Option
3rd Class Option
Registration Fee
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