RUMBA y FOLKLORE
in Matanzas, CUBA
May 15 – 29, 2004
REGISTRATION FORM.
YOUR FOCUS WILL BE ON: dance ……………. percussion ……………
NAME: ……………………………………………………………………………………
Last First MI
ADDRESS: ……………………………………………………………………………….
Street
…………………………. ………………. ………………
City State Zip Code
HOME PHONE: …………………………. WORK PHONE: ……………………
E-MAIL: ………………………………….. FAX NUMBER: ………………………
DATE of BIRTH: …………………………
PASSPORT#: …………………………….. EXPIRATION DATE ………………...
EMERGENCY CONTACT: …………………………… ……………………………..
Name relationship
…………………………… ……………………………..
Home phone Work phone
Are you allergic to any medication or do you have a medical condition you believe we should be aware of?
………….. …………… …………………………………………………………
Yes* No
*If yes, please explain
PAYMENT INCLUDED: total fee …………………..
deposit …………………..
balance due …………………..
AGREEMENT:
By signing this application form, you agree to the liability terms stated on the included liability agreement. You also agree that no portion of your payment is refundable in case of cancellation by you after the May 1st, 2004.Signature ……………………………………………………. Date: …………….
RUMBA y FOLKLORE
in Matanzas, CUBA
May 15 – 29, 2004
LIMITS OF LIABILITY / CANCELLATION POLICY
Please sign and return with your registration. Please read the following information carefully
in order to understand the limits of the service provided to you. Please make a copy of this document for your records.
I, ………………………………………, will be attending the Rumba y Folklore Program in Matanzas, Cuba from May 15th to May 29th, 2004. I hereby agree to assume all risks in connection with my attendance and participation in the Rumba y Folklore Program and agree to release its organizers from any and all liabilities and claims whatsoever arising in connection with my attendance and participation in the program.
I understand that I am responsible for arranging, obtaining and securing all travel arrangements to and from Montreal or other, previously agreed upon, point of departure. I further understand that the organizers of the Rumba y Folklore Program in Matanzas has made no representation concerning the safety of the methods of travel to and from the travel sites visited and thus, assumes no liability for injury, delay, irregularity, loss or damage to person or property or additional costs resulting directly or indirectly from: acts of nature, detention, weather, failure of any means of transportation to comply with schedules, quarantines, strikes, civil and military disturbances, theft, government regulations related to customs, immigration, violations of law, or trade embargoes, discrepancies and/or change in transit or living accommodations over which it has no control, whether it arises out of or is incident to the program or otherwise. I understand that reasonable changes in schedule or prices may be made at any time when deemed advisable for the comfort and well being of the
participants.I understand that Rumba y Folklore Program cannot accept any responsibility for the property of or personal illnesses of or injuries to any program participants during the program. Furthermore I consent to and authorize emergency and non-emergency care to be provided to me and/or my child in the event of a health problem or injury occurring during the attendance of the aforementioned activity.
I understand that Rumba y Folklore Program reserves the right to refuse to accept or retain
me as a program participant.Cancellation policy
I understand that the full payment is non-refundable after May 1, 2004. In case of cancellations after this date one hundred percent (100%) of the program fee will be retained by Rumba y Folklore Program.
I affirm that I have read and understood this document and agree to the terms stated above.
Signature: ……………………………………..
Print name: ……………………………………..
Date: …………………………………….