Todays Date____________________________________________

Class _________________________________________________

Class Date/Time _________________________________________  

Student's Name __________________________________________  

Age/Birthday ____________________________________________

Parent's Name ___________________________________________ 

Address ________________________________________________  

City ____________________________________________________

Zip ____________________________________________________
                     
Home Phone ____________________________________________

Work Phone _____________________________________________

Cell Phone ______________________________________________

 E-Mail__________________________________________________

Return with $20.00 Registration Fee to:
O'Donovan School of Irish Dance
Mary Rose Fansler
22 Campden Hill Road
Sherwood, AR 72120

(501)834-8591 OR (501)834-1479