Todays Date____________________________________________

Danced Irish Dancing in the past ?   (____)

Student's Name __________________________________________  

Age and Birthday _____  _______________________________

Parent's Names ___________________________________________ 

Address ________________________________________________  

City ____________________________________________________

Zip ____________________________________________________
                     
Home Phone ____________________________________________

Work Phone _____________________________________________

Cell Phone ______________________________________________

 E-Mail__________________________________________________

For new students - how did you hear about the school?

______________________________________________________

Return with $30.00 Registration Fee for one student, $40.00 for two students, or $50.00 for more than two students in one family, to:
O'Donovan School of Irish Dance
Mary Rose Fansler
22 Campden Hill Road
Sherwood, AR 72120

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