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Dance-India 2012 - Booking Application Form
Dance-India 2012 - Booking Application Form
Personal Information:
Full name of the participant: Full name of parent / guardian (if 16 and under)): Male Occupation Female Date of Birth: Age:
(Date/Month/Year)
Address:
Dance Information:
Advanced Bharatanatyam Intermediate Beginners
Kathak
Odissi How long have you been learning the above style and how many times do you attend the class / practice in a week Please give contact details of the dance teacher:
How did you hear about Dance-India 2012? (e.g. through e-mail/web-site/friend/event/other)
2008
2009
2010
No
Accommodation:
Accommodation for participants is arranged at Liverpool Hope University Halls, which are on campus just moments away from the Cornerstone Building where classes will be taught. All the rooms are single room with
an en-suite. Do you need accommodation arranged by Milapfest at the Liverpool Hope University Halls? Yes No
Dietary Requirement:
Are you vegetarian / non-vegetarian/ Vegan? --------------------------------------Do you have any other special dietary requirement? (Please Specify) -------------------------------------------
Health Information:
Do you have any health problem that we should be aware of? For example: Asthma, Epilepsy, Diabetes, Heart Problem, Allergies (Please specify)
Declaration
The above information is correct. I am fit and able to undertake the full time 8 days programme at Dance-India and take full responsibility of my well-being. I will withdraw from any activity unsuitable for my level of ability and fitness. I agree to the terms and conditions as specified above. Name & Signature of participants aged 17 & over Date: The minimum age requirement for this programme is 12 years. If you are 16 years or under, the adult responsible for you must complete and sign this section of the form. I acknowledge, as the adult responsible for the person named above, that Milapfest accepts no responsibility whatsoever, for accident or injury to that person or damage or loss of their personal belongings during the programme. Name & Signature of parent/guardian for participants aged 16 or under Date:
Booking will be accepted on first come first serve basis. It is your responsibility to ensure your application form and fees reaches us on time. Please email to confirm your application and fees has been received.
Please return this Booking Application Form via e-mail to: Shyla: shyla@danceindia.org.uk mobile: +44 7985 21231 www.milapfest.com Dance-India is produced by Milapfest, the Indian Arts Development Trust and supported by Arts Council England.
Registered Office: Liverpool Hope University Creative Campus, 17 Shaw Street, Liverpool L6 1HP, United Kingdom Tel : 0044 151 291 3949 | Fax: 0044 151 291 3883 | www.milapfest.com