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Location:
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New or Returning Student?
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Student 1 Name:
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Date of Birth:
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Student 2 Name:
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Date of Birth
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Student 3 Name:
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Date of Birth:
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Mothers Name:
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Fathers Name:
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Address:
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Email Address:
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Phone:
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Mom Cell:
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Dad Cell:
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Emergency Contact:
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Health Issues:
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If yes, explain:
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Academic School(s) attending 2011/12
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How did you hear about us/Referred By:
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I agree not to hold Moira McMahon, The McMahon School of
Irish Dance, The McMahon School Parent Group and/or any of its affiliates responsible for any loss, accident, or injury incurred on these and any other premises while my child is participating in dance lessons, shows, competitions, etc.
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It is understood and agreed that the participant is physically fit and prepared for participation in the activities which will be undertaken, and that the participant has not been advised by any doctor or other medical person that participation in these activities should be avoided and/or limited.
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I understand that my personal health insurance is responsible for any costs incurred if my dancer becomes ill or injured at the studio or at a dance-related event and requires medical attention or services.
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I agree to pay my tuition on time or incur a late fee.
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I would like to be included in the McMahon School directory.
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I give permission for my dancers' pictures to appear on the McMahon School of Irish Dance website, to be used in press releases, and be used for advertising & promotional purposes without compensation to my child or myself.
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How often do you check your email?
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I have read & agree with the Info/Policies of McMahon School: (Parent Signature Required)
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