Dynamic Dancerettes Dance Team Registration Form

Dynamic Dancerettes Membership Form

Complete the form below
Childs Name*

First NameLast Name
E-mail*
Phone Number:*

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:*

MonthDayYear
Insurance:*

Insurance ProviderPolicy Number
Grade*
Food and Allergies
Example: Pamela - Eggs
Current Medication that your child(ren) is taking
Example: Pamela - Hydrochlorothiazide
Additional Children - Please enter their Name, Grade, DOB, and Insurance Information
In Case of Emergency*

First NameLast NamePhone Number
In Case of Emergency*

First NameLast NamePhone Number
Membership/Privacy Policy Rules
1. Membership is available to anyone in the grade of 1st - 12th.
2. Practices are a MUST. Excused absences will be granted by Staff Members Only!
3. Monthly Membership Dues are $60 or depending upon how man you sign up for the team and is due by the 15th - 31st of each month.
4. There is a $55 Registration Fee which is non-refundable.
5. 1-2 Children ($60) - 3 Children ($75) - 4 Children ($100)
6. If you depart from this team, we asked that you leave our routines here as well.
7. The social Media Page (Facebook) is only for team members and parents. recording copies of the routines is Non-Prohibited.
8. Only authorized staff members (who have agreed to keep information secure and confidential) have access to your application information.
9. We collect personally identifiable and demographic information that is voluntarily submitted by our members parents/guardian. This information is only used to fulfill your specific request, unless you give us permission to use it in another manner.
10. I here by acknowledge that my child has a no known medical condition and/or allergies. In a case of an emergency I give DDDT permission to take my child to the nearest Emergency Room. In addition to that, I give consent that my child my have an OTC med. For example: Tylenol, Motrin, Benadryl for pain or allergy. DDDT shall not be held responsible if any information is untrue.
11. If there are any physical impairments please list them below.
Additional Physical Impairments (Example: Asthma)
Media/Publication
I do hereby grant the Dynamic Dancerettes the unlimited right to use and/or produce photographs, videos, movies, recordings, likenesses and/or the voice of MY CHILD in any legal manner and for the internal and external promotional and informational activities of Dynamic Dancerettes. I also agree to allow my child’s work and/or photograph to be published on Dynamic Dancerettes Dance Team fliers, media, and social outlets.

I will not pursue any residual if any is collected from the Dynamic Dancerettes Dance Team.
Parent/Guardian *

First NameLast Name
By checking this box and signing below it will be serve as consent from the parent/guardian of child named above.*

I have read, understood, and accepted the rules for membership.I have read, understood, and accepted the PRIVACY POLICY for membership.I have read, understood, and accepted the Media/Publication for membership.
Date*

MonthDayYear
Date
Please Sign*

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Registration and Dues$55.00

Total $0.00
Dynamic Dancerettes Staff
Founder/Director: Mrs. Pamela M Usry

Co:Direcrtor: (TBA)

Team Advisor: Beverly Parks

Team Advisor: Sierra Sturgis and Latoria Hart

Team Nurse/Record Keeper: Barbara Washington

Coaches: Tiona Orr

Team Accountant: Sierra Sturgis
Mission Statement

Dynamic Dancerettes Dance Team purpose is to create a team that is built on love, compassion, respect and dedication. While implementing showmanship and creativity through dance.

Payment Methods

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Dynamic Dancerettes Membership Form

Membership/Privacy Policy Rules

Media/Publication

Dynamic Dancerettes Staff