PLEASE READ CAREFULLY AND COMPLETE

Location: ………………….............

Day: M  T  W  T   F   S                                       Time: ................

 

NAME: ………………………………………..

 

ADDRESS: …………………………………………………………………..

               

TEL: ……………………….           MOB: ………………………

 

EMAIL……………………………………………………………

 

DATE OF BIRTH: ……/………/………….  AGE: ……………

 

Please state if your child suffers from any illness or disabilities, any medical problems, no matter how slight.

 If so what…………………..      Are they on medication? …………………   

If your child suffers from asthma, please insure they bring an inhaler to class very week.

 

Disclaimer: All students in activities conducted by the staff of 'Echoes of Erin' do so at their own risk. This includes damage to property or person immediately before,during and after classes! 

Signature: .................................................................................... 

 

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