(Please fill one form per family)
Please list at least two contacts
Name | Relationship | Phone No.
Please print two references
BY signing below parents and youth members waive rights of holding DIA responsible in case of any accident, misconduct, inappropriate language or actions.
Please fill all the above information, sign and send through one of the following methods.
Please write check payable to DIA
Email - firstname.lastname@example.org
Mail - DIA -318 Briarcliff Lane, Paramus NJ 07652
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