Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Did you arrive in Canada from Ukraine on or after February 24th, 2022? *

Yes

No

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact - Name *

First Name

Last Name

Emergency Contact - Phone *

Country

(###)

###

####

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)

*

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.