CYM/Одеса 2025-2026 - Сиракюз, Н. Й.

CYM/Одеса - Сиракюз, Н. Й.

Спілка Украінської Молоді - Одеса Танцювальний Ансамбль Ukrainian-American Youth Association - Odesa Dance Ensemble
Карта Реєстрації - Membership Form

2025-2026
Ім'я та прізвище - Member Name*

First NameLast Name
Дата народження - Date of Birth*

MonthDayYear
Date
Членство - Membership Type:*
Registration Amount - Ціна членства
Алергія - Allergies
Register Additional Member- Зареєструвати іншого учасника*

Member 2
Ім'я та прізвище - Member Name*

First NameLast Name
Дата народження - Date of Birth*

MonthDayYear
Date
Членство - Membership Type:*
Registration Amount - Ціна членства
Алергія - Allergies
Register Additional Member- Зареєструвати іншого учасника*

End Member 2

Member 3
Ім'я та прізвище - Member Name*

First NameLast Name
Дата народження - Date of Birth*

MonthDayYear
Date
Членство - Membership Type:*
Registration Amount - Ціна членства
Алергія - Allergies
Register Additional Member- Зареєструвати іншого учасника*

End Member 3

Member 4
Ім'я та прізвище - Member Name*

First NameLast Name
Дата народження - Date of Birth*

MonthDayYear
Date
Членство - Membership Type:*
Registration Amount - Ціна членства
Алергія - Allergies

End Member 4
Інформація про батьків або опікунів - Parent or Guardian Information
Name*

First NameLast Name
Email*
example@example.com
Mobile Phone Number*
Please enter a valid MOBILE phone number.
Additional Contact Information (anyone with email or mobile phone, including CYM/Odesa Member) - Додаткова контактна інформація (то має електронну пошту або мобільний телефон, включаючи учасники СУМ/Одеса)
Адреса - Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CYM Uniforms, CYM T-Shirts, Odesa T-Shirts
У визначений час, як частина цієї організації, ми просимо, щоб ми всі носили наші футболки або однострої. Будь ласка, переконайтеся, що кожна дитина має відповідну футболку та однострій. Додаткові футболки та однострої можна замовити тут.

At certain times as part of this organization, we ask that we all wear our t-shirts or uniforms. Please make sure that each child has the correct t-shirt and uniform. Additional shirts and uniforms may be ordered here.
Do you need to order a CYM T-Shirt?
Please select how many. Each T-Shirt is $10.00
Do you need to order an Odesa T-Shirt?
Please select how many. Each T-Shirt is $10.00
Parent/Guardian Consent and Liability Waiver*

I, the undersigned parent/guardian, understand and agree to a full and complete waiver and release of any and all liability on the part of theThe Ukrainian-American Youth Association (CYM), Odesa Dance Ensemble, and the Ukrainian National Home. I do not hold any of the parties associated with these organizations responsible but assume full responsibility for my child during this time in case of any mishap.
Participation COVID-19 Waiver*

For the purpose of this waiver, "I" shall mean the parents and/or legal guardian of the participant in the Ukrainian-American Youth Association and Odesa Dance Ensemble. As I or my child are enrolling to participate in the Ukrainian-American Youth Association and Odesa Dance Ensemble, by signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren)and I may be exposed to or infected by COVID-19 by attending in-person instruction at the Ukrainian-American Youth Association and Odesa Dance Ensemble and that such exposure may lead to any or all COVID-19 related symptoms, effects, or outcomes. I hereby release, discharge, hold harmless and covenant not to sue the SUkrainian-American Youth Association and Odesa Dance Ensemble for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Ukrainian-American Youth Association and Odesa Dance Ensemble or participation in any of their activities. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Ukrainian-American Youth Association and Odesa Dance Ensemble, it’s volunteers, employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Ukrainian-American Youth Association and Odesa Dance Ensemble, its volunteers, employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Ukrainian-American Youth Association and Odesa Dance Ensemble program. I agree to inform the Ukrainian-American Youth Association and Odesa Dance Ensemble if I or the Ukrainian-American Youth Association and Odesa Dance Ensemble participant has travelled outside the State of New York and furthermore agree to abide by all NYS COVID mandates relating to travel including but not limited to following quarantine restrictions in effect with respect to such travel and return to NYS. I have been advised of the social distancing and face mask rules imposed by the Ukrainian-American Youth Association and Odesa Dance Ensemble and agree to honor such rules at all times.
Name of Parent/Guardian completing this registration*

First NameLast Name
Date this registration is completed*

MonthDayYear
Date
Summary

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CYM T-Shirts

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Odesa T-Shirts

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Registration Total - Загальна сума:

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Payment*
Total Hidden
Total Calculation

Should be Empty:

CYM/Одеса - Сиракюз, Н. Й.

Карта Реєстрації - Membership Form

Інформація про батьків або опікунів - Parent or Guardian Information

CYM Uniforms, CYM T-Shirts, Odesa T-Shirts

Credit Card