2026 Glencastle Irish Dancers Summer Sampler Registration Form
Please complete one form per dancer registering.  Payment link will appear after form submission.  Registration is not complete until payment is processed.
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Parent/Guardian Name (First and Last) *
Parent/Guardian Email *All communication regarding the Summer Sampler will be sent here, so please list an email you check often!* *
Dancer's Name (First and Last) *
Dancer's Preferred Name/Nickname
Dancer's Date of Birth *
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Dancer's Session Selection *
Dancer's T-Shirt Size *
Does your dancer have any FOOD allergies/sensitivities?  *
Does your dancer have any MEDICAL/BEHAVIORAL diagnoses that you feel the staff should know? *

I certify that there are no health-related reasons or problems which preclude my/my child's participation in this activity or event. I will provide information from a medical professional should I/my child incur an injury where dance instruction needs to be limited. On behalf of my minor child, myself, and my household members, I hereby give permission for my child to attend classes at Glencastle Irish Dancers, Inc. and I acknowledge that my/my child's participation in classes is voluntary.

I acknowledge and agree on behalf of my child and myself that we shall:

- Abide by Glencastle Irish Dancers, Inc. policies/procedures regarding illness
- Agree to notify Glencastle Irish Dancers, Inc. and will not attend class if I/ he/she becomes ill.

I HEREBY WAIVE, RELEASE, AND DISCHARGE Glencastle Irish Dancers, Inc. and all divisions thereof of any and all liability and responsibility for injuries, sickness, pandemics, accidents, loss of property, death, natural disasters and/or acts of God incurred during participation in and/or instruction of classes, competitions, private instruction, performances or any activity I/my child may participate.

I CERTIFY THAT I HAVE READ THIS NFORMATION AND I FULLY UNDERSTAND ITS CONTENT.

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Please Type Parent/Guardian's Full Name to Acknowledge:
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