Access to Bollywood

Please fill out ALL FIELDS! (Only those marked with (~) are optional)

Participant Information
  1. M F
  2. S M L
Parental Information (if minor; adults please fill in the fields any case)
Emergency Contact
Standard Release (Fill in your name in both fields if Adult)
  1. I (parent in case of minor):
  2. do hereby release Shivanikan Inc and the hosting location from any liability in relation to the involvement with (the child's name)(s):
  3. involvement with the above listed camp or workshop. I also release the image of said child or children to ACCESS TO BOLLYWOOD for use in educational seminar related visual and audio presentations as well as promotional use in material directly related to ACCESS TO BOLLYWOOD. I also agree neither to hold the ACCESS TO BOLLYWOOD, nor the hosting location, responsible for any lost or stolen articles. I further agree that I / my child and family will adhere to ACCESS TO BOLLYWOOD rules and host location rules. It is also agreed that the Institute cannot accept the liability for the administration of medicines or medical treatment and it is understood that there is no qualified medical personnel on staff to do so. All medications, medical treatments and/or special dietary needs must be administered by the child and/or their parent(s) and all liability accepted thereof.
  4. How did you hear about us?
  5. Google Posters Website Commercial Blogspot.com
  6. THANK YOU SO MUCH FOR YOUR APPLICATION!
    WE LOOK FORWARD TO SEEING YOU!
    If you have any questions, do not hesitate to contact us.
Submit the Application & Make the Payment
  1.  I have read & agree to the Terms of Service
  2. Please select your program:
  1. Click "Submit" button to send in this application form and proceed with the payment (via PayPal, if you are ready to pay now).
    (If you have left empty any of the required fields, you'll be asked to fill them in.)
  2.  

Terms And Conditions

Cancellation

Individuals may withdraw anytime from the camp but may do so in writing. Telephone, fax and third party cancellations will not be accepted.

Refund Policy

Cancellation 90 days before the 1st day of camp: Refund less $750.
89 to 60 days before the 1st day of the camp: Refund less $1250.
59 to 30 days before the 1st day of camp: Refund less $1750.
29 days before the 1st day of camp: No Refund.

Agreement

I am an applicant and above the age of 18 yrs.

 I have read & agree to the Terms of Service.

Program:

Camp Highlights 2010

ACCESS TO BOLLYWOOD
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