Please print these 3 forms and fax or mail them to the information below. Not necessary if registering online. They must be postmarked and/or received on or before April 6, 2019 (for the very early savings rate) OR postmarked and/or received on or before June 5, 2019 (for the early savings date); July 5, 2019 (for the regular rate). Anything postmarked, faxed, mailed, received after July 5, 2019, must pay the "at the door rate" (see above). Thank you.
To save on space, paper and to be able to read it more clearly, if you'd like, you may copy and paste all the information into a Word document, type in what's needed and then print that out to send in.
Phone #: ___________
E-mail (please print very clearly):
***This is very important. As the full registrations come in, we will be sending out informational letters. Also you may be interested in communicating with one another about room/ride sharing, etc. to help one another with expenses. Thank you for printing clearly!
Age (if under 18) ______________________________
Children under 12 are free. However EACH child under 12 must be accompanied by a fully registered, participating, responsible adult, who has authority to sign their waiver form. Due to the largely ministerial nature of the conference we ask that you consider the attention span of your child before registering them. There will be no sideline mothers for any youth (even non-dancing moms can enjoy themselves and receive ministry). Thank you.
Enclosed please find (please check mark all that apply):
_________ $118 - Regular Rate - Received on or before July 5, 2019
_________Groups of 5 or more - $111 each**
_________Couples' Rate (husband and wife) - $109 each
_________ $132 - Door Rate - Received on or before July 19, 2019
_________Groups of 5 or more - $125 each**
_________Couples' Rate (husband and wife) - $123 each
________ Additional Love gift (helps offset conference expenses)
________ Total Thank-you, and may the blessings of God over take you!!!
PAYMENT METHOD - Please Circle One
MC VISA AMEX DISCOVER CHECK MO (US FUNDS ONLY)
CC# _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _
Please take extra room if you need to make it very clear to read
(CSC# for AMEX/DISC only) _____________
That is that tiny 3 or 4 digit number on the card.
Please make checks or money orders payable and mail to:
You may mail in your payment US FUNDS ONLY (check, MO, or Credit Card information) along with the registration, waiver and concert forms. However, we strongly encourage you to please register online. It is much easier and you do not need to send in any forms. It is a secure site as well.
Pastor Lynn does not want to display her personal address on the internet and we are trying to be good stewards of God's money by shutting down the PO box that hardly ever gets used. Therefore, if you absolutely must mail, please call to get an address: 863-398-8161 Thank you for your cooperation and understanding.
Or fax forms (with credit card info) to: 863-583-7398
The amount of registrations, offerings, support, etc., is non-refundable. If for some unforeseen reason you will be unable to attend, your tax-deductible donation will be considered a love gift or scholarship to further the work of God through Dancing For Him Ministries. Thank-you for your generosity. NO one-day rates available. We encourage you to attend the entire retreat or as much of the retreat as you are able.
**To get the group rate if you are mailing or faxing in your registrations. We must have the entire group's money and paperwork in all together, at the same time. NOTE: In order to get the price of what ever cut off date you are attempting, ALL - ALL PAPERWORK must be in by that date, or you will need to pay the next cut off rate. In other words, if you make your payment by the early bird cut off date, but we don't receive your 3 forms by that cut off date, then you will need to pay the next rate up. PLEASE SEND IN YOUR PAPER WORK WITH OR IMMEDIATELY AFTER YOUR PAYMENT to avoid paying the higher rate. Your paperwork alone will not hold your space. Only when we receive both the payment AND your paper work will you be considered fully registered and your spot will be held. Thank you.
WAIVER OF LIABILITY (ADULT-18YRS. OR OLDER)
Please fill in, sign and mail in with your registration.
OR if registering here online, simply agree with your electronic signature in the box at the bottom of this page. When registering a group and putting a yes in the waiver drop down, that means that everyone in your group agrees.
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., Lynn Hayden, Wil Bozeman 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 Workshop Date(s) of Program: July 19, 2019 to July 21, 2019
WAIVER OF LIABILITY - CHILD (UNDER 18 YRS.)
PRINT CHILDS 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., Lynn Hayden, Wil Bozeman 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 Workshop - Date(s) of Program: July 19, 2019 to July 21, 2019
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):_______________
OR if registering online, simply put 'yes' in the child waiver agreement drop down list, at the bottom of this page, then put their name in the comments box after the credit card information, upon check out.
CONCERT REGISTRATION FORM - BURNSVILLE, NORTH CAROLINA
Are you and/or your group participating in the Saturday evening concert? YES/NO
If yes, please continue and fill out this form. Mail or fax it in with your registration/payment/waiver. Please remember it is first come, first served . Only the first 12 dances that are fully registered will be able to participate. Once it is full, a notice will be posted here, just under the CONCERT REGISTRATION FORM heading.
OR Just select “Yes” in the drop down list below and fill in the appropriate information in the comments box after entering your credit card information, upon check out.
Individual Name ____________________
Name of Team Presenting: _______________________
Number of people in dance: ___________________
Name of Song to which you'll be dancing:____________________
Name of Artist: ____________________
Length of Song: _____________________(please, under 6 minutes)
Type of dance (worship, praise, hip/hop, mime, etc.): __________________