Student Registration Form- Eileen

October 2, 2011

Coyle School of Irish Dance
Student Registration Form for Eileen’s Classes ONLY
See other registration forms for Patsy’s classes, or Studio West Classes.

Please Note:
Tuition is non-refundable, nor is credit given for missed classes.
There is a $15 registration fee.

Dancing class year is the same as your child’s academic school year – September to June.
After Registration closes, the school will place all dancers into classes (except for the Championship dancers).

Students will be notified in August of their class placement.
Some class times may remain the same as last year, see the Class Schedule for the 2013-14 times.

General Class Information – Please read BEFORE registering.

Fill out form below and submit. ( •Required field)
*Family Name
Parent-Guardian
Address 1
Address 2
City, State, Zip
*Email
Home Phone number
Cell Phone number
Student 1
1 Name
1 Date of Birth
Student 2
2 Name
2 Date of Birth
Student 3
3 Name
3 Date of Birth
Choose One:
New Student Returning Student
Has your child ever had Irish dance lessons before?
Yes No
If yes**, what was the name of the school/teacher:
**A one time $25 transfer fee may be required if previous teacher holds their certification with An Coimisiún le Rince Gaelacha.
Class Location:
St. Dominic - NE Philadelphia
PDT Studio- 7500 Germantown Avenue, Philadelphia
Holy Martyrs Church, Oreland PA
Payment Options:
Discounted Full Payment - due by/on the first class in September Two Payment option - September, January
Registration Guidelines
1. I understand that being offered a payment plan is a courtesy extended to me and that I am responsible for all payment from September 2013 through and including June 2014, whether my student attends class or not.
2. By typing your initials below, you acknowledge and accept that Irish Dance is a physical activity that involves risk of injuries such as, but not limited to, sprains, breaks, muscle pulls, blistering, etc. Initialllng releases the Coyle School of Irish Dance, it’s teachers, and associates from any and all loss, injury, accident, or liability resulting from injury that is caused by Irish Dancing through dance lessons, shows, etc.
3. I further state that my child/children are in good health and are not restricted from any physical activities such as dance, etc.
*By typing your name into the box below you certify that you have read,
and agree to abide by the Registration Guidelines as stated above. .
*Type your name
To prevent excessive spam, please answer the question below.
Thank you!
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