First Name:

Last Name:

Email:

Phone:

Address:

City:

State:
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Zip:

Type of Registration

New
Returning

Mother's Name

Father's Name

Child's Date of Birth

Father's Email

Child's Email (If Appropriate)

Parent's Work Number

Parent's Cell Phone

Previous Dance Experience

Level of Competition

Do You Currently Take Classes In
Brooklyn
Mineola
Both
None

Comments (a box to tell us a little bit about yourself). Who is your favorite dancer? Who or what got you interested in Irish dancing? Has anyone in your family been an Irish dancer?

I Have Read And Agree To Our The Hold Harmless Waiver
I Agree
I disagree