DFH CLASS REGISTRATION

Simply Print these next few pages and mail or fax them in right away!!

REGISTER NOW! 

Name: ___________________________________________________________

Address:_________________________________________________________

City/State:________________________________________________________

Province/Country: _________________________________________________

Zip Code: _________________________________________________________

Phone #: _________________________________________________________
(include country code if foreign)

E-Mail Address: ___________________________________________________

Name of  Church You Attend: _______________________________________

Enclosed please find:
Please mark or write in the appropriate space(s)

MC            VISA            AMERICAN EXPRESS            DISCOVER            CHECK            MO 

EXPIRATION DATE:_________________________  CSC #__________________________

_ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _

SIGNATURE:_______________________________________________________________

Or fax form (with credit card info) to:
1(615)352-1902
 

PLEASE FILL IN, SIGN, AND MAIL IN
WITH YOUR REGISTRATION
Thank You.

WAIVER OF LIABILITY (ADULT-18YRS. OR OLDER)

PRINT NAME: __________________________________________________________________________________

In consideration of participation in this dance program and instruction, I the undersigned intending to be legally bound, here by for myself and anyone acting on my behalf, release any and all claims for damages I may have against Dancing For Him Ministries, Inc., Tom Hayden, Lynn Hayden and their sponsors, representatives, successors, and assigns for any and all injuries or death suffered by me in this program. I attest and verify that I know participation in this event can be a potentially hazardous activity. However, I have sufficiently prepared for this event and know that I am participating at my own risk. The waiver extends for the duration of the program. I also release DFH use of any video footage of me. I have read and understand this waiver of liability, and agree to the same.

YOUR SIGNATURE: _____________________________________________________________________________

DATE:_____________________________

Program: Worship Dance Training Classes —Date(s) of Program: ______________________________________

WAIVER OF LIABILITY - CHILD (UNDER 18 YRS.)

PRINT CHILD’S NAME:___________________________________________________________________________

In consideration of participation in this dance program and instruction, I the undersigned intending to be legally bound, hereby for myself and anyone acting on my behalf, release any and all claims for damages I may have against Dancing For Him Ministries, Inc., Tom Hayden, Lynn Hayden and their sponsors, representatives, successors, and assigns for any and all injuries or death suffered by me in this program. I attest and verify that I know participating in this event can be a potentially hazardous activity. However, I have sufficiently prepared for this event and know that I am participating at my own risk. The waiver extends for the duration of the program. I also release DFH use of any video footage of me. I have read and understood this waiver of liability, and agree to the same.

SIGNATURE (Child): ____________________________________________________________________________ 

DATE: _____________________________

Program: Worship Dance Training Classes - Date(s) of Program: _______________________________________

I am the parent and/or guardian of the aforementioned child. I consent to the waiver of liability on behalf of the child. I have read and understood this waiver of liability, and agree to the entire document intending to be legally bound thereby.

SIGNATURE (PARENT/GUARDIAN): ______________________________________________________________

PRINT NAME (PARENT/GUARDIAN):______________________________________________________________ 

DATE: _________________________
 

Dashan or Lynn: (615)352-1902

E-mail: workshops@dancingforhim.com