2023/2024 An Daire Academy Registration & Class Enrollment Form
Student Contact Information Form
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Email *
Student First Name & Last Name *
Student Date of Birth *
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/
DD
/
YYYY
Parents Name(s) (if participant is a minor) - First & Last
Paypal Associated Email Address: (for Tuition Payment) *
Contact Phone # *
Mailing Address (House # / Street, City, State, Zip) *
Known Allergies / Health Conditions:
Emergency Contact Info: *
Phone # (Emergency Contact) *
How did you hear about us?
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SUNDAYS - East Portland / Stites Dance Studio
MONDAYS - Oregon City / Dance Vision Studio
TUESDAYS - Online Learning Program
FRIDAYS - Hillsboro / Hillsboro Dance Center
Annual Registration Fee *
Required
Monthly Tuition
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