D.M.D HOLIDAY VACATION PROGRAM 12/26 - 12/29
DIVAS Mentoring divas INC; a youth mentoring entity that focus it’s efforts on improving the image and attitude of our next generation youth leaders. It’s the mission of the D.M.D staff to assist females in achieving academic/professional excellence and build a higher sense of self through performing arts and entertainment. We use the arts and entertainment through various Feminar’s as tools of engagement to further give young females life skills to SUCCEED!! Our program will be hosted at the BCYF PERKINS COMMUNITY CENTER 155 Talbot Ave. Dorchester, MA 02124. After completing this form, we will contact you only if we no longer have availability. Otherwise this form has secured your child's spot. All other forms will be completed & signed the first day of class. D.M.D Members will receive a discounted rate of $60.00/week. Please fill out one form per child. Feel free to contact us if you have any questions and/or concerns prior to paying the registration fee at 617-861-1256. Thanks
Is your child/student a new or existing DMD member? *
We're registering for week? *
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My form of payment will be paid by December 26, 2017 in the form of? *
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My child/student CAN'T attend a FULL Week?
I will pay a daily rate of $25.00 for the days listed below.
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Will your child/student participate in swimming if available? *
Life Guards ALWAYS on duty
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Please list your child/student's allergies. *
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My child/student has health coverage either under her parent/guardian or as an individual. *
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Physician Name, Number, & Hospital: *
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I'm aware that my child/student needs to bring a packed lunch and re-fillable water bottle everyday. *
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I'm aware that my child/student needs to bring a bathing suit in order to swim. (clothing not allowed) *
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How did you hear about our program? *
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Contact info
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Parent(s) Name *
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Phone number *
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Address *
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E-mail *
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Students Name *
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Students Age *
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Students DOB *
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Students Grade & School *
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Questions or Comments
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