Adult Class - Registration Form

Please complete the form below if you haven’t already completed one upon online sign up to a term

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email Address

Phone Number

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Additional Information

Here you may disclose any injuries or medical conditions you think we should know about. Please seek medical advice from your GP or medical professional if you are unsure whether to take part in an adult class.

I agree with the Terms and Conditions

Please see our terms and conditions below for further details. www.eastcoastballet.ie/terms-and-conditions

Yes

Register Details

Adult Class - Registration Form

Please complete the form below if you haven’t already completed one upon online sign up to a term