Parent Full Name *

Parent Phone # *

Parent Email *

Address *

City *

State *

Medical Release Information

I hereby give permission for any and all medical attention to be administered to my child in the event of an accident, injury, sickness, etc. under the direction of the physician (s) listed on the next page or at any necessary emergency facility, until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment this release is effective at least to the end of the dance season following the current season, but for not less than a period of one year from the date given. Hit "Next" to approve.

Physician Information

Child's Physician *

Physician's Phone # *

Physician Address

Physician City

Physician Zip Code

Allergies/Existing Medical Conditions

Allergies/Existing Medical Conditions (Please reply with "none" if there are no none allergies/existing medical conditions) *

Agreement of no known allergies or medical conditions

I Agree

Emergency Contact Name *

Emergency Contact Phone # *

Photo Release

I hereby authorize Disha Performing Arts to publish photographs taken of me/the undersigned minor children, and names, for use in the Disha social media accounts, websites, and/or printed publications.

I release Disha Performing Arts from any expectations of confidentiality for myself/undersigned minor children and attest that I am the parent, or the legal guardian of the children listed below and that I have the authority to authorize Disha Performing Arts to use their photographs and names.

I acknowledge that since participation in publications, websites and social media produced by the Disha Performing Arts confers no rights of ownership whatsoever. I release Disha Performing Arts, its contractors, and its volunteers from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.

Please Sign Here: *

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Attendance Policy

Students must be on time and should arrive at least 15 minutes early to prepare for practice. Dance is an art that requires consistent development and accountability, and as such, students are expected to be committed and attend on a consistent basis.

It is the student/guardian’s responsibility to inform their group instructor if they’ll be late for their scheduled practice. Any student arriving 10 minutes after the start of class, without notification, will need permission from their instructor to participate in practice.

If a student must miss a class, please notify a committee member or the instructor as soon as possible.

Poor class attendance or consistent tardiness may result in dismissal from performances, or expulsion from the group, at the discretion of the instructor.

If you have any questions or concerns, please contact:

Yusef Melgoush 714-851-5510

Onarmiss Ezmat 862-224-3301

Laura Karden 862-571-8158

By Checking the Box Below, You Agree to the Attendance Policy *

I Agree

Cancellation Policy

Out of respect for students and coaches, we take practice schedules very seriously. Dance will be treated like any sport or extra-curricular activity. It is our goal to communicate schedule changes immediately, weeks in advance, so families can plan accordingly.

We’re committed to communicate schedules changes and cancellations at least 24 hours in advance.

Only in case of emergency will practice be subject to cancelation within 24 hours.
Cancellations are the result, but not limited, to the following:
- Inclement or Dangerous Weather
- Coach Unavailability
- Holidays
- Medical

Please check box *

I Understand

Code of Xabzeh

Dancers must have a partial to full North Caucasian Decent (Adigha, Abkhaz, Karachay-Balkar, Dagestan, Chechen, Osset).
Dancers are expected to maintain a high moral character and, as such, must not engage in behavior that amounts to misconduct at the dance practices as well as at any community events or activities sanctioned by Disha Performing Arts. This includes off-site events, functions, and activities that the group has been invited to.

Students are expected to treat one another with the highest respect and courtesy and follow the instructions of their coach at all times.

Behavior considered to be misconduct may be defined as, but is not limited to:

Failing to follow defined procedures and rules, including instruction from the dance instructor or a dance committee member
Unacceptable, disruptive behavior

We want to create a safe, respectful, and welcoming environment for the well-being of all students. Students are expected to report unacceptable behavior and misconduct to their instructor or committee member immediately, in confidence. Retaliatory actions are strictly forbidden

Through sufficient due process, including permitting the dancer to present their position, misconduct may provide a valid reason for immediate termination and expulsion.

Please Check Box *

I Understand

We Welcome New Students!

We’re so excited to welcome you to our Disha community! Whether your child is new to Circassian dance or has experience, we’re honored to have you join our ongoing program.

At Disha, our mission is to preserve Circassian culture and traditions through the performing arts—and we’re thrilled to have your family be a part of that journey. We’re committed to creating a supportive, inspiring space where every student can grow, connect, and thrive.

We can’t wait to expand our “village” with you.

Welcome to the Disha Family!
Please complete one form per student.

Existing students do not need to re-register.