Registration Form – Deirdre O’ Mara School of Irish Dance

Student's Name *

Date of Birth *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Email *

Best Phone Number to call during class time *

Parent/Guardian 1 Name *

Parent/Guardian 1 Phone *

Parent/Guardian 2 Name

Parent/Guardian 2 Phone

Facebook Name for School FB Group

Have you taken Irish Dance elsewhere? If so, where?

Allergies, injuries, learning disabilities, etc.

I waive any liability against Deirdre O’ Mara School of Dance for injury, loss of personal property, or any and all illness while participating in any classes, camps, or workshops offered by the school. I knowingly and freely assume all such risks of possible exposure to and illness from infectious diseases, including but not limited to COVID-19, and assume full responsibility for my participation. I agree to comply with the stated and customary terms and conditions for participation regarding protection against infectious diseases. I as a parent/guardian have read and agree to abide by the guidelines in this registration information. If you do not want your child's photograph to be used in any Facebook posts or news stories, please inform us. Any issues concerning your child can be discussed by appointment or by phone. I am available by phone on Monday-Friday mornings. (201) 679-1450 *