Request of Chaperone Approval

Request of Chaperone Approval

The Teacher of Record and Chaperone must be registered and paid for the full National Convention and a DMA Member in good standing.

Approved Chaperone privilege shall not be extended to a Teacher of Record more than two (2) times within seven (7) years.

RE: Request for a Solo Title Chaperone

(See rules for chaperone requirements and responsibilities.)
Teacher of Record*

First NameLast Name
Chapter #*
Phone Number*
Email Address*
Name of Contestant & Division ($75 per contestant)
Name of Chaperone*

First NameLast Name
Chapter #*
Phone Number*
Email Address*
Chaperone Duties: Start Date*

MonthDayYear
End Date*

MonthDayYear
Teacher of Record will re-assume duties on...*

MonthDayYear
Reason for Request: *
(Must be urgent, unplanned, or an emergency which occurred after your Chapter's Solo Title Event.)
Chapter President or Secretary Email Address*
Signature of Teacher of Record (I have notified the Chapter President and Secretary of this request.)*

Clear
Date request was submitted.
If approved, a fee of $75 per entrant must be mailed to:

Dance Masters of America

c/o Charleen Locascio - National Treasurer

4621 Reich Street, Metairie, LA 70006
Should be Empty: