Registration Form

McGonagle School of Irish Dance 2010 / 2011 Registration

Student's Name___________________________________________________________________
                              Last                 First Middle

Date of Birth              ________/_______/_________
                                      month        day          year

Address ______________________________________________________

______________________________________________________

Telephone (________) ____________________________

Email Address __________________________________________________________

Mother's Name ___________________________ Cell or Wk # ___________________

Father's Name ___________________________ Cell or Wk # ________________________

Does your child have any existing medial conditions? YES_________ NO _________

If yes, please describe the condition and provide a Physician's note stating that it is safe for your child to participate in Irish Step Dancing Class.

Are you are returning McGonagle School student?               Yes              No

For returning students, did you dance competitively during 2010 and if so, in what level will you be competing in 2011?

If you are new to McGonagle School but have taken Irish Step Classes previously, please list the name of the previous school, the dates you attended classes there and your competitive level or years of dance.

______________________________________________________________________________________________________________________________________________________________________

Would you like to be included in and receive a school directory?                               Yes                            No

The directory will include the student's name, parents' names, address, telephone and email address. Please specify if there is any information you do NOT wish to appear on the school directory. The directory will NOT appear on the school website.

                                                                                                  _________________________________________

                                                                                                  Parent/Guardian Signature                                          Date

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Please return with registration fee and first months tuition to:

McGonagle School of Irish Dance

c/o Brenda Hamilton Coleman

7 Pearl Street

Wakefield, MA 01880

make checks payable to MSOID