AHERNE SHEEHAN
school of irish dance
2011-2012
REGISTRATION
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student name
date of birth
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address
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city, state, zip
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main phone
alternate phone
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email
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please note any allergies or medical conditions
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emergency
contact (name/relationship/phone number)
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parent or guardian names
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parent or guardian signature
By signing this registration form you acknowledge
and accept that Irish Dance is a physical activity that involves risk of injury. Your signature on the registration form releases
the Aherne Sheehan School of Irish Dance and its teachers and associates from any and all liability resulting from injury
that is caused by Irish Dancing. It also acknowledges your child’s photo may be taken
while participating in dancing activities and such photos may be used for promotional publication purposes, including online.
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please class or classes -- day/time/location
Please note: in registering for classes you are committing
to pay fees on a monthly basis from 9/11 through 6/12 inclusive. There are no exceptions – including
vacation, illness, injury, or other commitments.
