D'LYFE REGISTRATION FORM 2020/21

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Thank you for your interest in D'LYFE Dance Company. Please be sure to submit one form per child. Class size is limited to ensure control. You will be contacted to confirm that your child is registered. Payment instructions will follow after. Once confirmed a welcome info letter will be sent to all registered participants. If you have any questions or concerns please email us at info@dlyfedance.com.

Email *

Name of Child: *

Date of Birth: *

YYYY

Gender: *

Female

Male

Prefer not to say

Other:

Current Full Address: *

Phone Number: *

Allergies/Medical Conditions:

Parent Contact 1: (Name, Phone #, Email, Relationship) *

Parent Contact 2: (Name, Phone #, Email, Relationship)

Emergency Contact (Not residing with you... Name, Phone #, Relationship) ) *

Do you give the D'LYFE Staff authority to take initial steps to secure medical advice/service if your son/daughter requires medical treatment? If you do not give authority, the emergency contact will be contacted before seeking medical assistance. *

I give authority

I do not give authority

Required

Program Selection: *

Happy Feet

Juniors

Int. Division 1

Int. Division 2

Drumming

Required

Optional Dance Attire available for Pre-Order/Purchase:

1 for $15 D'LYFE T-SHIRT

2 for $25 D'LYFE T-SHIRT

$30 FOR XS/S FOLK SKIRT

$35 FOR M/LG FOLK SKIRT

$20 SUPPORTER T-SHIRT - D'LYFE CREW

$20 SUPPORTER T-SHIRT - D'LYFE MOM

Shirt size: (ie. 5T, 13/14, Adult M)

I give permission to have my child recorded or photographed by D'LYFE Staff for the purpose of learning or teaching materials. *

I consent

I do not consent

I give permission to have my child recorded or photographed by D'LYFE Staff for the purpose of promotional use for D'LYFE Dance Company *

I consent

I do not consent

I give permission to have my child photographed or recorded by the media and/or individually interviewed related to their participation in the D'LYFE program. *

I consent

I do not consent

Additional: Board Member Nomination

I wish to declare my candidacy for an elected position on the Board at the next AGM

By checking the box below, you agree and confirm that you, (Please checkbox before signing) *

I have read and understand the rules of conduct for participants and will assist your child/youth to abide by to them as well as the directions of the instructions at all times

are aware of the dance requirements and will respect the established standard; and

(*I) release D'LYFE Dance Company affiliates from any and all claims and causes of actions that I or my representatives have or may have in the future for personal injury or property damage occurring to my son/daughter, arising out of participation in dance program activities.

Required

Name of Parent/Guardian (In place of signature): *

Date: *

YYYY

Send me a copy of my responses.

Submit

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