Darby's Dancers Enrollment Form
Please complete this form with as much detail as possible. We will use this information to
partner our buddies with your dancer and for our team to review as we prepare for your dancer.
Let us know how we can make this a success for your child. We will do our best to include these elements in our teaching plans for your dancer.

Please take into account that although we do accept all dancers of all abilities there are certain limitations to enrollment.  Our buddies within our program are students in junior high or high school.  They are all wonderful and amazing youth mentors but they are not trained professionals.  There may be certain health requirements or behavioral needs that we as a program cannot provide services for at this time. We may need to discuss whether or not our program can properly accommodate your dancer. Please know we are continually striving to provide classes to all dancers!

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Date of Application *
Parent(s) Name *
Full Address *
E-Mail Address *
Home Phone *
Cell Phone *
Dancer's Name *
Nickname (if preferred)
Date of Birth (Month/Day/Year) *
School
Grade
Allergies?
What is your child’s diagnosis? Please be specific so we can prepare for his/her needs.
What items are addressed in their IEP or therapy plans that we can assist with or be aware of?
Does your student have a Behavior Intervention Plan (BIP)? 
Clear selection
If your student has a Behavior Intervention Plan (BIP), what behavioral needs are addressed on the BIP?
Is there anything specific you would like our “buddy” to do to help your dancer?:
Clear selection
Please check any of the following items that apply to your child:
What is your child's t-shirt size? *
Our teenage buddies are individuals who usually have experience in dance and/or leadership positions at their school. These young adults want to share their enthusiasm for dance, performing and serving. Their job is to help your child find success in coordination, work with focus, following directions, safety issues related to stability and encourage your child verbally and with praise or hugs. If care is needed beyond this level, together we will meet to discuss how we can work together to address their needs. Students must be able to exhibit basic communication skills, either verbal or nonverbal, so basic understanding can take place. Students with Special Needs need to exhibit appropriate social behavior and general self-control that is expected for their age with expected developmental disabilities. We are not trained special education experts and are not equipped to work with all students, including severe discipline problems or children with difficult medical care. We will seek to provide dance education to as many children as possible. Your child’s safety is of the utmost importance to us. If, for any reason, you have concerns regarding the safety/treatment of your child, please notify the Special Needs Director.  PLEASE INITIAL BELOW acknowledging your understanding of the above information. *
Photo and Video Release Agreement:     Please read the following statements and sign at the bottom of the page. By signing this release, I authorize the program to use pictures-including photo, motion and electronic images and voices -including sound and video recordings . I grant the right to publish, reproduce for all purposes and copy my image as needed for the benefits of the organization. I waive the rights for any compensation for the use of photos, audio, media and copyrighted materials. I acknowledge that I have read the following and I am in full agreement with this document.   Parent's Digital Signature-Please type your full name.
By signing my digital signature below,  I am acknowledging that I am signing for my under age child and on behalf of my family members, I grant permission for my child to participate in all aspects of Darby’s Dancers.    Parent's Digital Signature-Please type your full name.  
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