Participant Application Form 2012Personal Information:

Full name of the participant:

Full name of parent / guardian (if 16 and under)):

Male Female Date of Birth: Age: (Date/Month/Year) (Minimum age 12)

Occupation

Address:

Postcode:

Email:

Tel: Mobile:

Dance Information: Advanced Intermediate Beginners

Bharatanatyam

Kathak

Odissi

How long have you been learning the above style and how many times do you attend the class / practice in a weekPlease 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)

Have you attended Dance-India before? Yes 2008 2009 2010 No

Information for Administration Purposes:For administrative purposes, it is vital that we have details about your accommodation preferences, dietary requirements, condition of health, and emergency contact details.

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)

Contact details in case of emergency:

Name:---------------------------------------------------------------------------------------------------------------------------------------------

Land line:--------------------------------------------------- Mobile: ----------------------------------------------------

Relationship:------------------------------------------------ Email: -----------------------------------------------------

Terms and Conditions:

Milapfest reserves the right to substitute the teaching faculty advertised or alter the programme, without prior notice to the participant in the event of unforeseen circumstances.

While all reasonable precautions and information will be available for participants to ensure a safe working environment, Milapfest shall not accept responsibility for loss of property or personal injury during the programme.

Participants must make sure that they are physically fit to attend the programme as they will be involved in at least 8 hours of training each day including dance and physical fitness.

Accomplished, responsible youngsters between the ages of 12-16 will be admitted to Dance-India on the recommendation of their teachers which should be provided in a separate letter attached to the Booking Application Form. The admission will be facilitated only if a responsible adult who is a co-participant or a teacher takes charge of their conduct and wellbeing for the duration of Dance-India programme. All other Terms and Conditions herein will also apply.

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 21231www.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 KingdomTel : 0044 151 291 3949 | Fax: 0044 151 291 3883 | www.milapfest.com