MAIL TO:LDF Academy REGISTRATION FORM (S)
THE INTERNATIONAL LITURGICAL DANCE
ACADEMY
Student Registration & Application Form
Please complete the ILDF Student Registration form, the photo & video waiver form and the Liability Waiver Release Form and remit with fees to the International Liturgical Dance Fellowship. *Liability Consent & Waiver Release Form must be signed by each student prior to their 1st class.
Please print information below and mail to above address. Please include a photo with your application. (Professional quality photo only).
Date____________________________________________
Name___________________________________________
Date of Birth______________________________________
Current Address________________________________City___________________State______ZIP______
Home No#_____________________________
Cellphone No#__________________________
Work Number____________________________________
Email Address:___________________________________
Your website:____________________________________
Church affiliation: _____________________________________________________________________
Dance Ministry or School: _____________________________________________________________________
Number of years of dance training in: Liturgical____Ballet_____ Modern Dance_____ Jazz_____
Lyrical_____ Other______________________
EMERGENCY CONTACT INFORMATION:
Emergency Contact Person (s)
Name (s) ______________________________________
Address:______________________________________
Phone Number (s)_______________________________
Please attach resume of all dance related experience (i.e. performances, choreography, master classes, workshops attended etc.) In one or two paragraphs, please state what dance means to you and identify your dance career goals. Use the reverse side if necessary
Class Enrollment:Adult Classes (12 yrs to Adult) ______________
***
Adult Private Lessons Fee Extra $ 25.00 per hourPrivate lessons (beginner, intermediate or advance) Specify One: _____________________
NO REFUNDS FOR ANYONE FOR ANY REASON AT ANY TIME
(Fees listed annually)Fees are subject to change each calendar year.
(In state students) Adult Monthly fee $100.00 paid in advance or monthly payments
(for one year Certificate Program) Payment plans available.
Out of state students discount available * please call for more information. Praise Garment requirements please see manual. Checks made payable to ILDF*Previous dance training? If yes explain use back of application. YES _____ NO_____
*Are you a member of a dance ministry, school, troupe? YES_____ NO _____
*If yes please list them:Are you a member of a church or religious group?
YES _____ NO _____
Student’s Name:
____________________________________________________________
Print Name
________________________________________________________
Signature above
______________________________
Date: X____________________________________
X____________________________________
Parent or Legal Guardian (print & sign)
Date:________________________________
MAIL TO:
ILDF Academy
P.O. Box 32456
Pikesville, Maryland 21282
443-739-6672
Advance Registration Required
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LIABILITY WAIVER
Very Important Read Carefully
I am aware and am in full agreement that neither myself, family member (s), friends or associates will hold ILDF its directors, staff, other students, volunteers responsible for any injury, incident (s), or death due to my attendance, activity, participation or travel with the International Liturgical Dance Fellowship. I nor my family member (s), friends or associates will not bring any legal action or lawsuit (s) of any kind for any reason at anytime against ILDF its directors, staff, other students, or volunteers whether in connection with loss or damage of property / person, any injury, incident (s), or death due to my attendance, activity, participation or travel with the International Liturgical Dance Fellowship.
Signature:_____________________________
Date:_________________________________
Legal Guardian of Youth
(Print and Sign):_______________________________Date:______________
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Photo/Video Waiver
The International Liturgical Dance Fellowship would like to publicize information about our ministry, dance training, or programs that are available, and we can do this through use of pictures or video.I hereby give my consent for photographs and/or video to be used for promotional purposes and may be added to the photo gallery of the ILDF at anytime for any reason. I waive any and all right to payment (s) for use of my photographs, video, or likeness of me. I understand that this waiver does not expire.
ILDF Volunteer Form
Please return this sheet with your registration form
Name:Phone Number:We are always seeking volunteers to work with our director and coordinators. Please indicate which areas you maybe interested in. These are non paid temporary volunteer assignments. Circle area of volunteer interest.
Sewing
Class Teacher or Assistant (You must be selected by Dr. Franca for this position)
Music / Sound Operations
Usher
Decorating
Intercessory Prayer
Photographer / Misc. Pictures
Videotaping
Birthday / Get well / Sympathy / Thinking of you cards and calls
Catering (Full or Asst.)Intercession and Prayer: We are standing in need of prayer throughout the year and prior to ministry assignments. If you would like to be on a prayer chain, would be available to pray regularly or otherwise, please contact Dr. Franca 443-739-6672.
Student’s Name:
____________________________________________________________
Print Name
____________________________________________________________
Signature above
______________________________
Date:
X____________________________________
Parent or Legal Guardian (print & sign)
Date:________________________________
MAIL TO:
ILDF
P.O. Box 32456
Pikesville, Maryland 21282
Advance Registration Required
*You may bring to orientation / All forms are due prior to classes
