Kelly Academy of Irish Dance Online Registration

Kelly Academy of Irish Dance

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Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

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Contact #2

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Student #1

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School*

Grade Level*

Shoe Size*

Disabilities (Leave blank if NONE)

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Prior Irish Dance Experience*

Previous School Name

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

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Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Shoe Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Irish Dance Experience*

Previous School Name

Student #3 (Show-Hide Details)

Student's First Name*

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Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Shoe Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Irish Dance Experience*

Previous School Name

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Shoe Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Irish Dance Experience*

Previous School Name

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Shoe Size*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior Irish Dance Experience*

Previous School Name

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Referral Information

Family Information

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Contact #1

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Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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