Laois Dance Academy  Registration Form

www.laoisdanceacademy.com
Ph: 087 1328852
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The cost of term 1 is €75 for classes up to 30min and €85 for 45minutes classes or longer.                                                                                                                 If you’re taking extra classes, there’s an extra €65 per class that you add.To make payment via PayPal, please follow this link:  https://www.paypal.com/paypalme/my/profile                                                                If you’re not a PayPal user, you may also transfer or lodge your fee to:  Laois Youth Dance Ensemble;  ULSTER BANK  ;    Account 12749021 ;Sort code 986235  ; Iban: IE34ULSB98623512749021    ;    Bic: ULSBIE2D
Please choose a class: *
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Student's Full name: *
Date of birth: *
Parents(s) Name(s): *
Address: *
Contact number: *
Any  Known allergies/illness that may affect your child while dancing: *
Any further comments regarding your child’s dancing: *
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 *
Required
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 the term fee (non refundable).                  The cost of term 1 is €75 for classes up to 30min and €85 for 45minutes classes or longer. If you’re taking extra classes, there’s an extra €65 per class that you add. *
Signature (Please type initials and full name) *
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