Playshop Registration Form 2010        

Registration is limited to 10 participants. There is a waiting list when playshop is filled.

 

Please complete this form and send to:

Rob Kennedy

6-1855 Maple Ridge Dr,

Mississauga, On  L4W 2N7

 

Name_____________________________________________________________________                  

 

Address___________________________________________________________________       

 

Postal Code________________________ Ph: _____________________________________

 

E-mail ____________________________________________________________________    

              

     [ ]    1-Day     Lens Painting  (Emotion in Motion)                 Oct 10^th              $85.00

 

     

     [ ]   1-Day     Shot in the Dark (Night Photography)                 Oct 16^th              $85.00

 

 

      [ ]   1 -Day    Fun with Perspective                                       Nov 6^th                   $85.00

                       

 

      [ ]    1 -Day    Extreme close-up                                            Nov 7^th              $85.00

 

           (Food & Lodging not included)

Please check one:

 

[ ]  I have enclosed $85.00 as payment in full for the 1-day playshop.                                   

                             

[ ]   I have enclosed $250.00 as payment in full for all 4 playshops.(over 25% discount)

 

Waiver of Liability

I agree that during this playshop, Rob Kennedy and his agents shall not be liable or responsible

for any claims or damage arising from personal injury to any participant or other person or for any damage, loss or theft of personal property of any participant or other person, however caused.

Rob Kennedy reserves the right to alter the time, context or format of the playshop to suit the needs

of the participants should circumstances require.

 

Signed  ____________________________________________________

  Date     ___________________________________________________