2021/2022 DYMA AFTER SCHOOL REGISTRATION

PARENT/LEGAL GUARDIAN'S INFORMATION

STUDENT INFORMATION

What Location Are You From? *
Which DYMA Location Will You Attend? *

DETAILS

2021-2022 PRICE (Price can be changed!) *
First week deposit is required and there are no refunds. 
Authorization *
This Program Includes: 
- Homework Assistance
- Taekwondo Classes
- Physical Exercise Class
- Arts, Crafts, STEM, and Fun Games
- K to Middle School
- Follow all State Regulation Guidelines
- Safe & Clean Environment
- Class size is limited
Terms and Waiver:
I agree to waive any and all claims against Dragon DYMA Martial Arts and all people connected with it. This contract serves as permission to have my child(ren) transported to any health care facility and for him/her to receive any and all emergency health care should the situation arise. 

As we are all aware, children are prone to mishaps. Although Dragon DYMA Martial Arts makes every effort to have adequate supervision, occasionally accidents can happen.  In the instance that an emergency arises, we would need your specific permission to transport and have your child treated by a professional care giver/physician, etc. DYMA will not be responsible for any liabilities issues occurred.

For the safety and well being of our students and staff, Dragon DYMA Martial Arts reserves the right to remove any child from our program. 

By signing below, I verify that all the above information is correct and that I agree to the terms stated above.

Signature of Applicant/Parent/Guardian *
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Click the Submit Button at the bottom to complete your application!
ONCE WE HAVE SUCCESSFULLY RECEIVED YOUR APPLICATION, WE WILL CONTACT YOU TO DISCUSS PAYMENTS & OTHER DETAILS.

PURCELLVILLE

310 N 21st St, Purcellville, VA 20132
540- 338- 6660

BRAMBLETON/DULLES/MOOREFIELD

22895 Brambleton Plaza #110, Brambleton, VA 20148
703 - 542 - 7326

LEESBURG

528 Fort Evans Road, Leesburg, VA 20176
571-271-8039