Speech and Drama Sign Up

Parent/Guardian *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Mobile Contact Parent /Guardian *

Email *

Number of children enrolling *

Child's Name *

Date of Birth *

Age of child *

Second Child *

Date of Birth *

Age of child *

Third Child *

Date of Birth *

Age of child *

Please indicate which venue you wish to attend *

Athlone (Monday)
Moate (Tuesday)
Glasson (Wednesday)
Ballinasloe (Thursday)
Private Classes Glasson (Friday)
Athlone (Saturday)

Please indicate below if the above child/children suffers from any medical condition/allergies (specifying any medication she/he may be taking) any physical or learning difficulties experienced by your child. Please advise if your child has resources in school.

In the event of my son/daughter being taken ill or injured so that medical attention becomes necessary, I hereby authorise the teacher(s) in charge to sign on my behalf any written forms of consent required, provided that the delay necessitated to obtain my signature might endanger my son/daughter’s health or safety *

Getting to know your child/children is important to me, please inform me of any specific likes or dislikes your child may have.

We occasionally take photographs or film children in class to use in publicity material, or parents may wish to video their children as they perform. Please choose below *

Allow photography
Do not allow photography

In respect of the GDPR Data Protection Act (1988-2018), I would like to seek your consent to retain your details for the sole purpose of further correspondence, during the academic year, and until September 2023 where I will seek further permission to hold your details on file. *

Yes
No

Preferred payment option *

Pay deposit now to secure enrolment, or
Pay total now

Number of Children for Term 1 Sept to Dec OR Term 2 Jan to May

One per term - 150,00 €
Two siblings per term - 285,00 €
Three siblings per term - 420,00 €

Please tick the number of participating sibling students

Total *

0,00 €

Number of Children for Term 1 Sept to Dec OR Term 2 Jan to May enrolment deposit *

One student deposit per term - 20,00 €
Two siblings deposit per term - 40,00 €
Three siblings deposit per term - 60,00 €

Please tick one option above based on the number of participating students

Deposit Total *

0,00 €

Stripe Credit Card *

Card

Name on Card

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