Desna Collective | Ages 18+ Registration Form 1. MEMBERSHIP Membership runs from Mid - September 2023 - Mid - May 2024. Classes include : Ballet warmup, Ukrainian Dance, 2 performances throught the year (Dec & May) and costumes. 2. DANCER INFORMATION Name * First Name Last Name Date of birth * MM DD YYYY Gender * Male Female Prefer not to say Did you arrive in Canada from Ukraine on or after February 24th, 2022? * Yes No Email * Phone * Country (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country 3. EMERGENCY CONTACT & MEDICAL INFORMATION Emergency Contact - Name * First Name Last Name Emergency Contact - Relationship * Emergency Contact - Phone * Country (###) ### #### Emergency Contact - Email Medical Conditions / Injuries * Does you have any medical conditions or injuries that Desna and/or the instructor(s) should know about? 4. VOLUNTEERING Are you interested in volunterring with Desna School? * Yes No If yes, please select the volunteering options that you would be interested in Help to organise the christmas concert Help to organise the spring concert Lead or assist with a fundraising event Lead or assist with christmas carolling Other (please let us know your ideas) 5. ACKNOWLEDGEMENT & CONSENT * I accept responsibility for all possible risk of injury (see below) and hold Desna, its Instructors and Board of Directors blameless in the event of damage before, during and/or after rehearsals, trips, shows and other events, both within and outside of Desna’s studios. In the event of injury, the current instructor, and/or Desna is authorized to seek emergency medical assistance on my behalf. (Injury including, but not limited to muscle strains, pulls or tears, broken bones, shin splints, knee/hip/lower back/foot injuries, heart attacks, and any other illness, soreness, or damage, including death, however, caused). I acknowledge that Desna has its own Covid-19 protocols in place and is adhering to government and rehearsal space guidelines, policies and protocols. Any personal information provided by myself is for the sole use of Desna and will not be made available to anybody (publicly or privately) without my permission. I confirm that I have read and fully understood the Desna code of conduct and constitution, and agree to follow all the rules and applicable penalties outlined in these documents. If any damage is found to the costume, I agree to pay a CAD $100 costume fee. I agree to pay the annual membership by e-transfer (treasurer@desna.ca) and is due at the time of registration - alternative payment plans can be discussed with the treasurer. By clicking submit, I confirm that I have read, understood and filled in the above information correctly. Thank you for submitting your registration form. If you have any questions please reach out to:treasurer@desna.ca