Events :: Denbaya West African Intensive :: Registration with cheque payment

Denbaya Online Registration with cheque payment

To submit your registration for the September 3-6 MoonDance Dynamic Arts School Denbaya West African Intensive and pay by cheque or money order, please follow these steps:

Type your name and other information into the form below and select desired class(es) and other options, and click on the submit button.
Lynn will email you an invoice for the total owing.
Once you have paid, you will be officially registered.

Fees

Full camp (all meals, accommodation, all lessons and t-shirt): $425 by June 3rd; $475 after June 3rd
High ropes / low ropes / climbing wall $50

Non-participant prices — meals + accommodation for non-participant (e.g. spouse or child):
Guest day fee: $7.50 + meal costs: breakfast or lunch: $9, dinner: $11
2 and under are free; 3-5 yrs are half-price; over 5 pay regular day & meal fees
Accommodation: free for age 2 and under; $15/night child (3-15); $20/night adult (16+)

MANDATORY FIELD = *

1. Personal Information:

*First Name:

*Last Name:

*Phone:

*Email:

*Address:

*City:

*Province: Please use 2 letter abbreviation

*Postal Code:

*Allergies:

Meal preference:

Regular
Vegetarian
Vegan

Special Dietary Requirements:
(For allergies it is suggested that you speak directly with the Chef. Please check this box if you wish to be contacted regarding this.)

2. Emergency Contact Information:

*Name:

*Relationship:

*City:

*Phone:

Alternate Phone:

3. Non-Participant Guest Information:
Guest Day Fee: $7.50 + meal costs. Half price for age 3-5, free for 2 and under.

Guest 1: Name:
Emergency Contact:

Number of days:
Number of nights accommodation:
Number of breakfasts:
Number of lunches:
Number of dinners:

Guest 2: Name:
Emergency Contact:

Number of days:
Number of nights accommodation:
Number of breakfasts:
Number of lunches:
Number of dinners:

Guest 3: Name:
Emergency Contact:

Number of days:
Number of nights accommodation:
Number of breakfasts:
Number of lunches:
Number of dinners:

Guest 4: Name:
Emergency Contact:

Number of days:
Number of nights accommodation:
Number of breakfasts:
Number of lunches:
Number of dinners:

4. Participant Registration Options:

Check all that apply:

Full Camp - $425 by June 3rd, $475 after June 3rd
High ropes / low ropes / climbing wall - $50

7. Comments

(max. 40 characters per line):

NB: No alcohol is allowed on site.
No pets.
Swimming is only permitted on-site during the times the life-guard is on duty. If you would like to swim outside of these times, please go to the Provincial Park next door, or to one of Shawnigan's public beaches.

Waiver

By registering to participate, I am accepting risk of an accident occurring. MoonDance Dynamic Arts School will take necessary and appropriate safety precautions and will attempt to minimize any associated risks. Examples of the types of injury that may occur while participating in these activities include, but are not limited to: unusual pain or discomfort, such as from stubbed toes, injuries resulting from human error. I am aware that my participation involves some risk, and that my participation is voluntary. I hereby agree to waive any and all claims that I have or may in the future have against MoonDance Dynamic Arts School, and to release the School, its officers, employees, and representatives from my and all liability for any loss, damage, injury, or expense that I may suffer as a result of voluntary participation in the program. I agree to seek clarification of the proper method of movement, and that the staff of MoonDance Dynamic Arts School has the right to stop me from doing exercise that they feel would be harmful to me. I will inform the instructor of any unusual pain, discomfort, fatigue, or any other symptoms I may suffer during or immediately after participation. I have read and understood the contents of this agreement.

* I have read and agree to the above waiver: Yes No

By agreeing to this document you will waive certain legal rights, including the right to sue.

YES! I would be interested in receiving MoonDance e-news for info on upcoming workshops, performances, classes, schedule changes, etc.

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