Please print and fill out this form.
New familes: Enclose a $25/per family registration fee (non-refundable)
payable to Kathleen O'Keefe Parents' Association
Returning families: Enclose a $15/per family registration fee
and mail to:
Kathleen O'Keefe School of Irish Dance
c/o Mary Leisner, Registrar
33 Hunters Lane
Rochester, NY 14618
email: kokeefeschool@yahoo.com
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Kathleen O'Keefe School of Irish Dance
New/Existing Family Registration Form
2007-2008
Student Name (Last, First) Age Date of Birth
1.__________________________ ______ ___________
2.__________________________ ______ ___________
Address: ___________________________________________________
___________________________________________________
Phone number (including area code): ____________________________
Alternate phone number: ___________________ Is this a cell phone? y__ n__
Email address:_____________________________________
Name of Parent/Guardian (please identify relationship if not parent)
__________________________________________________________________
Previous Irish Dance experience?
None_____ less than 1 year____ more than 1 year_____
Where did you hear about our school?
website___ friend/family____ other (please specify)____________________
If referred, who were you referred by? ________________________________