Youth Membership Permission Slip

(Please fill one form per family)

Your son/daughter has signed up to be a member of the DIA.

Members Name:
1. 2. 3.

Member Email Address:
1. 2. 3.

Member Cell No:
1. 2. 3.

Mother's Name:

Father's Name:

Mother's Email:

Father's Email:

Mothers Cell:

Fathers Cell:

Grade:

Date of Birth:

Home Phone No:

Address:

Hobbies & Interests::

List any allergies:

Emergency Contact Info

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 Check One

As a Parent

I allow DIA to release my son/daughter's pictures for DIA's website, press release and events. I agree with the DIA code of conduct rules.
I do not allow DIA to release my son/daughter's pictures for DIA's website, press release and events. I disagree with the DIA code of conduct rules.

As a Youth Member

I will act in a responsible, courteous manner when using DIA's website blogs and comment section. I will abide by DIA's code of conduct rules.

Please fill all the above information, sign and send through one of the following methods.

Please write check payable to DIA

Email - info@dia-usa.org

Mail - DIA -318 Briarcliff Lane, Paramus NJ 07652

INFORMATION:

Members must attend at least 5 out of 8 monthly meetings
Members must be of 7 -19 years of age, pre-youth (7-10), youth (11-19)
Volunteer work or meetings will be announced as per schedule
DIA is a non-profit organization and does not take any direct responsibility of the members.
DIA membership is renewable every year. The fee for first child is $50.00, additional child is $40.00
Any concerns or questions must be referred to DIA Directors by email at info@dia-usa.org
Check are payable to DIA
Members must attend two major annual fundraising events to show support of DIA

DIA CODE OF CONDUCT

The Dedicated Indians of America Foundation is an independent non-profit organization.
DIA members and parents please note that it is essential for DIA members to realize that they are solely responsible for their own behavior and attitude and that DIA cannot be held responsible for any member's misconduct.
Safety is a constitutional right. Parents, DIA members and Directors need to work together to see that these rights are upheld by everyone in our organization.
DIA members are expected to dress appropriately considering weather, community norms and the need for safety.
DIA board of directors reserves the right to terminate membership of DIA youth member at any given time if the member or parent fails to comply with DIA rules and regulations.
BY submitting membership below parents and youth members waive rights of holding DIA responsible in case of any accident, misconduct, inappropriate language or actions.

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