New Students / Student Registration

Clann Kelly - Houston Irish Dance

Student Registration

Information entered in this form will strictly be used for internal purposes only and will not be shared outside of Clann Kelly.

* Indicates required field

Registration Type *

New Student Current Student

Student First Name *

Middle Name *

Last Name *

Date of Birth *

MM/DD/YYYY

Guardian First Name *

If student is not a minor, please re-enter student name.

Guardian Last Name *

Relationship to Student *

Please enter 'Self' if you are the student.

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Student Medical Information *

Emergency Contact Name *

Emergency Number *

Emergency Relationship to Student *

Irish Dance Level *

Beginner Advanced Beginner Novice Prizewinner Preliminary Championship Open Champsionship

Please select beginner if the student has no Irish dance experience.

If the student has any dance experience other than Irish Dance, please list the style(s) of dance and level achieved for each style.

Previous Dance Experience *

How did you hear about Clann Kelly? *

Internet Search Social Media Performances Referral Other

Referral Name/Other *

Questions and Comments *

If you have any question regarding Clann Kelly or Irish Dance, please fill out this section and we will get back to you as soon as possible.

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