DIVAS Mentoring divas 2019 - 2020 Fall Registration
Welcome! Please fill out one form per child. Feel free to contact us if you have any questions and/or concerns at 617-861-1256 or DivasMentoringDivas@gmail.com. Each session ends with a recital performance. Costume fees subject to change based on fundraising. Please pay tuition by clicking the registration button on our website. Answer all questions/statements if not applicable be sure to fill in N/A. Class location and confirmed entry will be individually emailed after payment and form have been completed. Costume & Photo payments will be collected during class once info is determined please acknowledge by checking boxes on this form. Days and times subject to change with advance notice. Stay up to date check our site often. www.DMDinc.net Thanks
Email address *
Child's Full Name: *
Your answer
Are you a new member? *
Which program is your child/student attending? *
Required
Sessions/Payments (Check all that apply) *
Required
Costumes (TBD based on fundraising) *
Required
Class Photos (Receive digital photos) *
Required
I/We understand that it is my/our responsibility to bring any special concerns about my/our child/student to the School Director’s attention at the time of registration. I/We understand that D.M.D Inc. reserves the right to dismiss a Student, based on the School Director’s judgment of any/all improper events. If the Student’s behavior interferes with the rights of others, the functioning of the group or activity, or violates the (D.M.D Inc. ) principles of conduct; in such cases, no refunds will be given. *
I/We give permission for my child to be photographed and/ or videotaped and for (D.M.D Inc. ) to use the pictures and videos for publicity purposes. It is understood that (D.M.D Inc. ) will not identify my child/student by name on any website or public production. *
HEALTH WARRANTY: Participant warrants and represents that his/her child/student has no disability, impairment, or ailment that will prevent him/her from engaging in active or passive exercise or that will be detrimental to his/her student’s health, safety, or physical condition if the child/student does engage or participate. If my child/ student has asthma, I agree to provide inhaler everyday and deliver to coach before school starts! *
Please list your child/student's allergies. *
Your answer
My child/student has health coverage either under her parent/guardian or as an individual. *
Required
Physician Name, Number & Hospital: *
Your answer
I'm aware that my child/student needs to bring a pre-filled water bottle to every class. *
Required
I'm aware that my child/student needs to wear black leggings, practice shirt and black sneakers to practice! *
Required
I understand that there is a late fee of $1.00 every min after 5 mins for late pick up. *
Required
Child/Student T-Shirt Size (Include Adult or Youth) *
Your answer
Child/Student Leotard Size (Include Adult or Youth) *
Your answer
How did you hear about our program? *
Required
Contact info
Please enter the following info:
Parent/s Name *
Your answer
Phone number *
Your answer
Childs Nickname *
Your answer
Childs Age *
Your answer
Childs Grade & School *
Your answer
Questions or Comments
Your answer
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