The Carrolier Academy of Irish Dance - Online Registration - Las Vegas, NV
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Dancer's Full Name
Dancer's Age
Dancer'sDate of Birth
Sex
Female
Male
Parent/Guardian Full Name
Address
Home contact Number
Cell Number
E mail Address
Would you like your contact information to be published in the student directory?
Yes
No
Have you taken Irish dance instruction previously?
Yes
No
If so please list the dance school and the dates you attended
Please list any medical conditions you would like us to be aware of
Have you read our liability waiver
Yes
No
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