Last Name_______________________ First Name___________________DOB________
Parents Names: ____________________________________________________________
Address:___________________________________________________
__________________________________________________Telephone:________________________
Please provide email address since it is a major means of communication within the school
Email address: ________________________________________________________________________
**** Parents, please list any health conditions that we need to be made aware of before your child
participates in Irish Dance classes.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
___________________________
Emergency Contact Name and Number: ____________________________
_____________________________________________________________________________
A $20.00 registration fee is required of all new students.
Checks should be made out to M. Lorady TCRG, and submitted with this form.
If returning by mail, please use the following address:
McCoy School of Irish Dance
C/O 417 Stanford Road
Fairless Hills, PA 19030
MCCOY SCHOOL OF IRISH DANCE REGISTRATION FALL 2008