Registration Form : PDF

(please use BLOCK CAPITALS)


Name:  ______________________________

 

Address: ______________________________
 
  ______________________________

  ______________________________

  ______________________________


Age:    _______________   Date of Birth: ____ /____ /____

 

Tel. No. (Home)__________________ (Mobile) ___________________


E-Mail: _________________________________

 

In case of emergency contact person and number __________________________


Any illness/allergies/disabilities we should be aware of? _______________________________

 

School: ________________________________Class Year: _______________


Country of birth: ______________________________  Year of arrival in Ireland: _________

 

Have you ever been involved in Theatre, Drama or Stage Productions: 

Yes      No

 

If yes give details: _________________________________________________________

________________________________________________________________________

 

Hobbies/Interests/Musical ability:

________________________________________________________________________

 

The Co LYT is an initiative of Limerick County Council.  If you have any questions/queries please do not hesitate to contact us on 083 071 7162. By completing this information you are agreeing to be contacted with information pertaining to youth theatre and drama.

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Contact Details

Honey Fitz Theatre, Lough Gur, Patrickswell, Co Limerick

 thecountylimerickyouththeatre@gmail.com      Tel 083 0717 162