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KSA Irish Dance Registration '23-'24
Please fill out the following information to register for Irish Dance this year!
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MAIN CONTACT EMAIL ADDRESS
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Your answer
Dancer's First Name
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Your answer
Dancer's Last Name
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Your answer
Dancer's Date of Birth
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Your answer
Dancers Age as of 1/1/23
Your answer
Dancer Medical Info/ Allergy (if any)
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Your answer
Address
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Your answer
Parent/ Guardian 1 First & Last Name
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Your answer
Parent/ Guardian 1 Cell Phone
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Your answer
Parent/ Guardian 2 First & Last Name
Your answer
Parent/ Guardian 2 Cell Phone
Your answer
Emergency Contact
Name, Phone & Relationship
(Please list someone OTHER than the above guardian/s- this contact is in case parent/ guardian does not answer)
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Your answer
Level (Refer to email for level if returning student)
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Level 1 (New Beginners Age 3-4)
Level 2 (New beginners age 5-6 OR age 4 w/ at least 1 year KSA exp)
Level 3 (New beginners age 8+/ Soft Shoe Only)
Level 4 (Soft Shoe & Intro to Hard Shoe)
Level 5 (Soft & Hard Shoe)
Level 6 (Soft & Hard Shoe)
Preferred form of payment:
Zelle
Venmo
Cash
Check (Made out to Kerri Smith)
CC (+3%)
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Waiver:
Click here to view waiver.
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I have read and agreed to the Waiver/Terms.
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