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Laois Dance Academy Registration Form
Please choose a class: *
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Student's Full name: *
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Date of birth: *
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Parents(s) Name(s): *
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Address: *
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Contact number: *
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Any Known allergies/illness that may affect your child while dancing: *
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Any further comments regarding your child’s dancing: *
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Please note that dancing and body movement is a “hands on” activity for the purpose of corrections, better explanation from the instructor/teacher and is also used in partnering or group work. If you do not wish that child to have body contact with others in class, please tick no *
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Laois Dance Academy may take photos and videos of class activities to use in local media for promotion of the School, If you object please tick 'no' *
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I understand this registration is only valid after the payment of 50% of the term fee as deposit (non refundable) *
Signature (Please type initials and full name) *
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