Bethlehem Traditional Irish Dance Homeschool Class Registration
Please fill out a separate form for each dancer and pay on the older student’s form only
Mondays 11:30am-12:30pm February 2-March 16
Student Information
Note -- if filling out for a sibling, only fill out personal info section
Name
First Name
Last Name
Age
*
Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Let us know if you/your child has any health concerns or other restrictions we should know about:
Parent/Guardian Information
For minors (below 18 years of age)
Parent/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
My Products
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Single student fee
$
85.00
Two students
$
150.00
3 or more students
$
225.00
Total
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Print Form
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