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Girl Project Virtual Hangouts::2020
Wednesdays 4-5:30pm
Via Zoom
Contact us at
dnagagirlproject@gmail.com
Zoom link will be sent to eligible participants via email address and phone number provided
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Email
*
Your email
Which session are you interested in
*
December 23rd Hangout
Required
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Nickname
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Student Cell Phone #
Your answer
Student Mailing Address
*
Your answer
Is this a secure mailing address for receiving supplies?
Yes
No
Clear selection
If not, is there and alternative that you would prefer?
Your answer
(1) Parent/ Caregiver Name
*
Your answer
(1) Parent/Caregiver’s Phone
*
Your answer
(1) Parent/ Caregiver Mailing Address
*
Your answer
(1) Parent/ Caregiver Email Address
Your answer
Language spoken at home
Your answer
Do you require an interpreter?
Yes
No
Clear selection
How do you prefer to be contacted?
Email
Phone
Mail
Clear selection
(2) Parent/Caregiver’s Name
Your answer
(2) Parent/Caregiver’s Phone
Your answer
(2) Parent/Caregiver’s Mailing Address
Your answer
(2) Parent/Caregiver’s Email Address
Your answer
Language spoken at home
Your answer
Do you require an interpreter?
Yes
No
Clear selection
How do you prefer to be contacted?
Email
Phone
Mail
Clear selection
Emergency Contact (other than listed above)
Your answer
Emergency Contact Phone
Your answer
Student Information: Current Academic School:
*
Your answer
Student Information: Dietary restrictions
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
Student Information: Current Medications?
*
Your answer
Student Information: Shirt size
*
XS
S
M
L
XL
XXL
Student Information: Pants Size
*
Your answer
Student Information: Shoe size
*
Your answer
Image Release dNaga strives to share images that reflect our programming and dance community. We may take photographs and video/audio recordings during the workshop and performance for inclusion in a variety of media. We will not share your daughter’s full name or school with the public. Do we have permission to share images of your child participating in Girl Project programming?
*
Yes
No
Please initial and sign below: I GRANT PERMISSION to dNaga to publish, reproduce and distribute photographs, electronic images or video of my daughter. This permission extends to printed materials, broadcast media and the dNaga website.
*
Your answer
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