Registration Form Student Name * First Name Last Name Name of Parent or Guardian * First Name Last Name Date of Birth * MM DD YYYY Address * Parent/Guardian Contact Number * (###) ### #### Secondary Contact Name and Number * Parent/Guardian Email Address * Number of Classes per Week * 1 Class Per Week 2 Classes Per Week 3 Classes Per Week Class 1 Day and Time * Class 2 Day and Time (If Applicable) * Class 3 Day and Time (If Applicable) * Medical Conditions * Does your child have any additional learning requirements in order for our teachers to ensure the very best learning experience? * Any Known Allergies * I accept the terms and conditions of this registration * https://www.corkschoolofdance.org/school-policy-terms-conditions Yes Date of Submission * MM DD YYYY Please not that from time to time photographs are taken of the students for entry into the press, advertising material and social media. Do you consent for your child to be featured in school photography and videography? * Yes No In the event of illness or accident, I give permission for medical treatment to be administered where considered necessary by a suitably qualified medical practitioner and/or hospital. I understand that every effort will be made to contact me as soon as possible. * Yes I understand the personal data on this form will be used by Cork School of Dance for the purpose of registering my child, and will be retained by CSD for the duration of CSD membership. It will be used primarily for administrative purposes to deliver information regarding term dates, fees and exams. * Yes I confirm that fees have been paid via bank transfer, or as discussed Yes Date of Payment (Bank Transfer or Equivalent) * MM DD YYYY Thank you!
