Different Directions Registration Form
Please fill out one form per child.
Email address *
Students First and last name *
Students Date of Birth *
Students Age *
Students email (this will only be used for class purposes with permission from parent)
Name: Parent or legal guardian 1 (Name of person completing the form) *
Parent or guardian 1 email *
Parent or guardian 1 phone number *
Parent or guardian 1 physical address *
Parent or guardian 2 full name ( If only one parent mark N/A) *
Parent or guardian 2 email ( If only one parent mark N/A) *
Parent or guardian 2 phone number ( If only one parent mark N/A) *
Parent or guardian 2 physical address if different from parent 1 ( If only one parent mark N/A) *
Emergency Contact Name: (Your emergency contact is someone other than a parent who can be called if neither parent is available in case of an emergency) *
Emergency Contact phone number: (Your emergency contact is someone other than a parent who can be called if neither parent is available in case of an emergency) *
Emergency Contact email: (Your emergency contact is someone other than a parent who can be called if neither parent is available in case of an emergency) *
Please list all students allergies and the severity of the allergy (if any) *
Does your child take any medications that we need to know about? This would be a medication that would effect your child's health or ability to attend class if the medication is not administered. Please note if your child takes medication during the day that will need to be monitored. *
Child's special needs (if any) *
Does your child have any siblings attending classes at Different Directions? Please list their first and last name if applicable *
Release and indemnity
I understand and agree that participation in classes, events, field trips etc. hosted at and by Different Directions Inc. entails the possibility of physical injury. By signing this release form, I voluntarily assume all risk and responsibility for any such injury or accident which might occur to me or to my minor child before, during or after events, clubs, classes or field trips sanctioned by Different Directions Inc. I also release and indemnify Different Directions Inc., it’s employees, agents, volunteers and guest artist from any and all claims, demands, or causes or action whatsoever for any loss or damage, including, without limitation, personal injury, to me or my minor child, or for loss or damage to personal property, which may arise out of or in connection with participation in any classes, clubs, field trips or activities conducted by Different Directions Inc. I hereby voluntarily waive my right, and that of my heirs and assigns, to hold, Different Directions Inc. their officers, Advisors, employees, agents, volunteers or guest artists liable for any such damage, loss or injury. If I am signing this waiver for my minor child, I certify that I am the parent or legal guardian and have the right to waive these rights. With this registration I give permission for me, or my child, to be photographed or filmed for use in Different Directions Inc. publications, including, without limitation, newsletters, brochures, publication via website or other technological publications, videos, newspapers, radio, or television. No photos or film will be made available to anyone for any reason other than to promote Different Directions Inc. I understand that my email address will be used for communication regarding scheduling, announcements and information about my classes at Different Directions.
I have read and accept the release and indemnity agreement. *
Absence and Proration Policy
If your child is not going to be in class please call or email the teacher so they know your child is not coming. Different Directions does not have the ability to offer make up days or prorate the class fee for sickness, traveling, acts of nature or humane error outside of Different Directions. IE: storms, snow, hurricanes, train or bus trouble, terrorists, vacations, illness, or other unforeseen acts of nature or man, etc. If a teacher is sick they will schedule a makeup day (if there is an open day available) or offer some compensation such as (but not exclusively) a discount for the next term. Different Directions programs and class are not prorated for late registration. Our prices are by the term and cannot be altered due to a student starting after the term begins.
I have read and understand the Absence and Proration policy *
Refund policy
There are no refunds for students who withdraw after the term begins or are asked to leave a class for breaking our behavior policy. Teachers base their expenses on the number of students they have at the beginning of the term. All teachers and organizers at Different Directions are responsible for their own expenses including space fee, assistant fees and supplies. Once a class has begun, the money paid to the teacher has been distributed to space, assistants (if needed) and materials. They have paid these non refundable fees under the agreement that your child will be in attendance for the term. Once the term has begun the spot your child holds cannot be replaced.
I have read and understand the refund policy *
Required
Behavioral policy
Different Directions is a safe, nurturing space for children and their families to find connections. We are dedicated to respecting our members, young people, planet and community. Bigoted, discriminatory, aggressive, subversive, threatening behavior will not be tolerated. Such behavior is subject to immediate termination and expulsion from Different Directions classes, activities and events. The ultimate decision will be made by the Operating Director and board of directors of Different Directions Inc. I understand that myself, child and any guest I bring into Different Directions, will not do intentional damage to the physical plant of Different Directions Inc, or any space while attending a Different Directions class, activity, field trip, or function. I understand that if my child, mine or any of my family or guests actions are aggressive, disrespectful or damaging in any way I may be asked to terminate all activities at Different Directions. Those actions include but not exclusively pertain to, participating in bigoted, discriminatory, threatening behavior that targets students, parents, teachers, organizers or guests; for racial, gender, physical, cultural or personal differences.
I have read and understand the behavioral policy *
All children 11 and under must be picked up by a parent or guardian named on file. If chose your child's dismissal plan. *
Please write the name of the people other than the parent or guardians, who have permission to pick up your child. *
Monday online classes - Please indicate what classes you are interested in.
Tuesday Online Classes - Please indicate which classes you are interested in.
Tuesday On Campus Classes-Please indicate which classes you are interested in.
Wednesday Online Classes- Please indicate which classes you are interested in.
Wednesday On Campus Classes - Please indicate which classes you are interested in.
Thursday Online Classes- Please indicate which classes you are interested in.
Friday Online Classes - Please indicate which classes you are interested in.
Please confirm you are the legal guardian of the child named in the registration form *
Registration Fee
There is a $50 yearly registration fee per child. Please follow the link to pay via paypal.com to payments@differentdirections.org
A copy of your responses will be emailed to the address you provided.
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