Riverchapel Afterschool Ballet

Every Friday
1:40pm - 2:40pm Junior pick up
2:40pm - 3:40pm Senior pick up
From September 19th - December 19th
€130.00 for the full term

A guardian needs to fill in and submit this form.

Name

First Name

Last Name

Date Of Birth

YYYY

Class

Teacher

Emergency contact name:

Emergency contact number:

(###)

###

####

Medical issues/Allergies:

Just type N/A if their are no medical issues or allergies.

Consent to use photos:

Yes

Consent to send you marketing emails:

Yes