Desna Company | Registration Form 1. MEMBERSHIP LENGTH & COST Membership runs from September 1 2024 - August 31 2025. The cost of membership is CAD $700 2. MEMBERSHIP TYPE * Existing Desna member re-registering New Member 3. DANCER INFORMATION Name * First Name Last Name Gender * Male Female Prefer not to say Date of birth * MM DD YYYY Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country 4. EMERGENCY CONTACT & MEDICAL INFORMATION Emergency Contact - Name * First Name Last Name Emergency Contact - Relationship * Emergency Contact - Email * Emergency Contact - Phone * (###) ### #### Medical Conditions / Injuries * Does you have any medical conditions or injuries that Desna and/or the instructor(s) should know about? 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). Desna follows its own Covid-19 protocols, adhering to government and rehearsal space guidelines. All personal information provided will be used solely by Desna and not shared without my permission. * I agree to complete 15 volunteer hours of time towards Desna. If 15 hours are not completed by the end of August 2025 a charge of CAD $10 per uncompleted hour will be charged to me. I agree to pay the annual membership fee of CAD $700 by e-transfer (treasurer@desna.ca) and is due at the time of registration - alternative payment plans can be discussed with the treasurer. By submitting this form, I confirm I have read and understood the Desna code of conduct and constitution and agree to follow all rules and penalties outlined. 7. NEW MEMBERS COSTUME DEPOSIT As a new member, I agree to pay a CAD $100 costume deposit in case of damage to or loss of Desna costume property. This deposit is refunded upon leaving Desna. 8. PARENTS / GUARDIANS FOR THOSE AGED 18 AND UNDER As my child's parent / guardian I provide my consent and agree to let my child participate in activities with Desna Ukrainian Dance Company. As my child's parent / guardian, I confirm that I have read and fully understood the Desna code of conduct and constitution, and my child agrees to follow all the rules and applicable penalties outlined in these documents. As my child's parent / guardian, by clicking submit, I confirm that I have read, understood and filled in the above information correctly. Parent / Guardian Name Todays Date MM DD YYYY Thank you for submitting your registration form. If you have any questions please reach out to:treasurer@desna.ca