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.