EmailMe Form - Expression Of Interest

Email address
Parent / Guardian *

Please supply an email address that is checked regularly, preferably a personal address and not a work address.

Applicant Name *

First Last

Applicant Date of Birth *

DD / MM / YYYY

Male

Female

House/Apartment No. *

Street Address/Road Name *

Address Line 2

Town *

County *

Eircode

Parent / Guardian Name 1 *

First Last

Parent / Guardian Phone 1 *

Parent / Guardian Name 2

First Last

Parent / Guardian Phone 2

Details of any Medical Condition, Special Needs or any other details that we should be aware of...
IF NONE PLEASE STATE SO *

Please list any Dance experience/training and styles of Dance which you excel at.

How many hours a week do you train at Dance

List all Performing Arts Schools attended Past / Present or any Representative / Agent you have in the Performing Arts Industry.

How did you hear about WestSide?

Checkbox *

I consent to allowing Westside Performing Arts contact me by Email and/or Text Message.

Checkbox *

I consent to the data entered on this application to be stored on Westside Performing Arts Database.