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Daphne's Yellow Rose Memorial Fund
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D&G Dance Company
Registration
-
Once completed you will receive a comfirmation email. Please check your junk folder.
Dancer (s) First Name
D&G Dance Company
Dancer (s) Last Name
Parent/Guardian Name/Email
Address
Phone
Doctor Name/Phone Number/Preferred Hospital
Dancer (s) Age/Dance Experience
Class (s)
Optional GIFT OF DANCE SCHOLARSHIP DONATION- 1 class/2 classes/specified amount
Release of Liability
Submit
By clicking the submit button you are agreeing to the
RELEASE OF LIABILITY
above.
You will receive an email confirmation.
Thank you!
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