Quigley Academy of Irish Dance
2026-2027 Registration Form

*Returning Students DO NOT need to fill out a new registration form.*
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Parent/Guardian Name OR Dancer Name (if over 18)  *
Dancer 1 Name *
Dancer 1 DOB *
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Dancer 1 Level (if known) *
Dancer 2 Name
Dancer 2 DOB
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DD
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YYYY
Dancer 2 Level (if known)
Clear selection
Dancer 3 Name
Dancer 3 DOB
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DD
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YYYY
Dancer 3 Level (if known)
Clear selection
Dancer 4 Name
Dancer 4 DOB
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DD
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YYYY
Dancer 4 Level (if known)
Clear selection
Address *
Parent/Guardian (or dancer over 18) phone number *
Parent/Guardian (or dancer over 18) email *
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Phone Number *
Please list any allergies, medical information, or otherwise important health and safety information that teachers should be aware of (all information disclosed is kept confidential). 
If the dancer/s being registered are over 18 years of age or older, each dancer must complete one waiver below. 

If the dancer/s being registered are below 18 years of age, a parent/guardian must complete the waiver below.  

I, _________________ (parent/guardian OR dancer to enroll) listed to participate in dance during the current session at the Quigley Academy of Irish Dance.

In case of any type of injury or sickness, I hereby waive all claims against the Quigley Academy, its owner, its instructors, and its employees. I release from responsibility any person transporting myself/my child to the doctor or hospital, in case of emergency.

I understand that classes may be changed, cancelled or rescheduled as required, after reasonable notice.

I understand I will not receive full or partial refund for paid tuition if I/my dancer discontinues classes. In the event the dancer registered above decides to discontinue classes, I will inform the Quigley Academy by phone or email.

*
Required
I provide my consent for pictures taken during Quigley Academy of Irish Dance classes, performances or other events that include myself/my child to be used in social media posts or advertisements for the Quigley Academy. *
Required
Date of Form Submission *
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By clicking the 'Accept' button, you are agreeing to the terms of this registration form. *
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