Afterschool GLAM Registration

Welcome to DDS GLAM After School Program!

We are very excited to have the opportunity to serve you and your children.

Please complete the application listed below. We do have a registration fee of $55.00 for DDS GLAM Afterschool Program, that includes class practice attire.

We provide a discount for families with multiple children. Please let us know upon registering so that discount can be applied. Thank you!

Parent\Guardian Name:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Number:

(###)

###

####

Email:

Student's Name:

First Name

Last Name

Gender:

Date of Birth:

(format as follows: mm/dd/yyyy) Ex: 09/15/2003

Name of School:

Grade Level:

Disabilities:

Special Needs:

Ex: (ADHD, ASD, Behavior Disorders, Dyslexia)

Allergies:

Ex: (Peanuts, Dairy, Seafood, Soy, Pineapples, Tomatoes, etc*)

Medications:

Please specify administration of any medications for the student. Please provide the name of the medication, reason the medication is given, time of duration medication is needed, and any known side effects to be aware of including any other special instructions that we should know)

Emergency Contact:

Who should we contact in case of an emergency? (Please provide their First & Last Name and their relationship to the student*)

Emergency Contact Number:

(###)

###

####

#2 Student DAP Registration Form

Student's Name:

First Name

Last Name

Gender:

Message

Date of Birth:

Format as follows: (mm/dd/yyyy) Ex: 09/20/2001

Name of School:

Grade Level:

Disabilities:

Special Needs:

Allergies:

Please provide any allergies that the student may have. Ex: (Peanuts, Dairy, Soy, Pineapples, etc*)

Medications:

Required Policies & Agreements:

Assumption of Risk:

Assumption of Risk: The individual signing this agreement assumes all risk associated with the student participating in dance class, rehearsals, and any other studio related activity. Said person assumes responsibility for any ACCIDENTS, INJURY, OR LOSS OF PROPERTY

I've read the terms above and I agree.

Release of Liability:

Release of Liability: DESTINY DANCE STUDIO AND INSTRUCTORS ASSOCIATED WITH THE COMPANY ASSUME NO LIABILITY FOR ACCIDENTS, INJURY, OR LOSS OF PROPERTY AND THE SAME SIGNING THE AGREEMENT ON THE BEHALF OF SAID STUDENT ASSUMES RESPONSIBILITY THEREOF. I AUTHORIZE AND AGREE TO ALL MEDICAL ATTENTION NECESSARY FOR MY CHILD IN THE EVENT OF ACCIDENT, INJURY, AND/OR SICKNESS.

I've read the terms above and I agree.

Payment Policies:

Payment Policies: WEEKLY TUITION PAYMENTS ARE DUE FRIDAY BEFORE THE WEEK OF PARTICIPATION. ANY PAYMENT PAID AFTER THE FOLLOWING FRIDAY WILL OCCUR A LATE FEE CHARGE OF $10 DOLLARS. TUITION DUE IN EXCESS OF THREE WEEKS MUST BE SUBMITTED IN FULL PRIOR TO FURTHER SCHOOL PICKUP. NO DAILY REFUNDS ARE GRANTED ONLY WEEKLY IF PRIOR NOTICE WAS GIVEN FOR ILLNESS OR DEATH IN THE IMMEDIATE FAMILY. IF CLASSES ARE POSTPONED DUE TO WEATHER OR OTHER UNAVOIDABLE CIRCUMSTANCES, MAKE UP CLASSES WILL BE ARRANGED. I AGREE TO PAY THE WEEKLY TUITION FOR THE AFTER-SCHOOL PROGRAM. I WILL STILL BE RESPONSIBLE FOR WEEKLY FEE UNLESS PRIOR NOTICE IS GIVEN FOR VACATION OR THE SCHOOL IS CLOSED. WHEN LEAVING AFTER-SCHOOL PROGRAM A TWO WEEK NOTICE MUST BE GIVEN PRIOR TO EXITING AFTER-SCHOOL PROGRAM IN ORDER TO NOT BE CHARGED WEEKLY FEE.

I've read the terms above and I agree.

Transportation Agreement

Transportation Agreement: I GIVE PERMISSION FOR MY CHILD CARE PROVIDER, OR ANY APPROVED EMPLOYEE OF THE DESTINY DANCE STUDIO PROGRAM, TO TRANSPORT MY CHILD(REN) FOR THE FOLLOWING REASONS LISTED: SCHOOL PICKUP, FIELD TRIPS, EMERGENCY PURPOSES, AND ANY REASON DEEMED NECESSARY BY THE PROGRAM It is agreed that: 1. The caregiver will never leave my child(ren) unattended in any motor vehicle or other form of transportation. 2. Each child will board or leave a vehicle from the curb side of the street. 3. All child(ren) will be secured in safety seats or by safety belts as appropriate for the age of the child(ren) in accordance with the law. 4. Any motor vehicle used to transport my child(ren) will have current registration and inspection stickers, and must be operated by a person who is at least 18 years of age and possesses a valid driver's license. 5. The caregiver will notify me in advance of any instance where my child(ren) will be transported while in care.

I've read the terms above and I agree.

I agree to all of the terms above

(Please type your first & last name to confirm, sign, and complete above agreement)

Payment Information:

Account Information: e-payment schedule

Card Issued As:

Credit Card Number:

Card Expiration Date:

Ex: Format As Follows: Month/Year - (04/21)

Card Nickname:

Name on card

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have any Questions or concerns that you’d like to share with us?

No worries - visit our contact us page to get in touch!

We’d love to hear from you!