on Parker Pond, Mount Vernon, Maine
Resident Participant Application Form — Summer 2012

This form is for Resdent Participants only.  Go to the Day Participant form.

(* indicates required fields)


First Name:*
   		Last Name:*
   		Birthdate:*
   
Male  Female *

Address:*
   		City:*
   		State:*
   		 Zip Code:*
   		 Country:*

Home Phone:*
   		Cell Phone:
   		Work Phone:
   		E-mail Address:*

Dietary restrictions/requirements:


Emergency contact Name:*
   		 Relationship:*
  

Home Phone:*
   		Cell Phone:
   		E-mail Address:*


Briefly describe your education and arts experience (dance, music, theater, other).*


If you have a résumé or CV, please e-mail it to Bearnstow Administration.

Check if applying for a Work/Study. E-mail Bearnstow Administration after completing application.

Check if applying for Tuition Reduction. Write the workshop instructor directly to apply.


Bearnstow Workshops — Choose the workshop you wish to attend.

  July 1–14 (two weeks): Sara Shelton Mann and Ruth Grauert — Performance Is Communication
  July 15–21: Peter Kyle — Slow Tempo
  July 22–28: Robin Gilmore — Mapping the Human Terrain
  July 29–August 4: Tim Harling — Tools You Can Use: Performance Skills & Creative Approaches
  August 5–11: Claire Porter — Writing and Moving: A Creativity Retreat
  August 12–18: Allyson Jones — The Five Elements of a Healthy Life

(If you wish to attend more than one workshop, please e-mail admin@bearnstow.org.)


Fee Schedule for Resident Participants:

Application Deadlines: On or before April 1, 2012 On or before June 1, 2012 After June 1, 2012
One-week workshop $675 $725 $775
Two-week workshop $1215 $1315 $1415

     A non-refundable deposit of $50 is required to complete this application form, or you may pay your total fee (as indicated in the schedule above) with the application. Unless paying in full, the balance wll be due two weeks prior to your arrival at Bearnstow. Return to the bottom of this page or the Workshops page to go directly to Bearnstow’s PayPal page to pay your balance.

     You may pay your fee ($50 deposit or the full tuition) by credit card though PayPal or by check mailed to Bearnstow. If you are applying for Work/Study or Tuitiion Reduction from your instructor, pay only your deposit now. Please specify the following two options:

1. Amount of Payment: *

      Deposit only ($50)

      Full tuition for one week, $675

      Full tuition for two weeks, $1215
2. Method of Payment: *

      By credit card through PayPal

      By check mailed to Bearnstow. *

Waiver of Liability and Acceptance of Bearnstow Policy — The following Waiver of Liability and Acceptance of Bearnstow Policy must be printed, signed, and mailed to Bearnstow to validate your application:

WAIVER OF LIABILITY: In no event will Bearnstow, its officers, directors, instructors, or assigns be liable for injuries or loss of any kind to the person or property of participants in its programs, including, but not limited to, leisure and class activities, dancing, boating, swimming, walking or hiking, horseback riding, cooking, or using building and equipment. I hereby assume all risks and agree to hold Bearnstow harmless for any loss, damage, injury or inconvenience in connection with any program or activity while I am at Bearnstow.

CANCELLATION POLICY: We reserve the right to cancel any workshop due to circumstances beyond our control. In case of cancellation, we will refund all payments made to BEARNSTOW. In no case will our liability exceed the amount paid to us.

ALL PHOTOS, VIDEOS, AND PRODUCTIONS made during the workshops are common property for all to share.

ACCEPTANCE: Rules for acceptance and participation are the same for all without regard to religion, race, age, gender, sexual orientation, or national origin.

Download the Waiver of Liability document PDF version or MS Word version.

 I can download and print this document.   No, I cannot download or print; please mail it to me. *

In submitting this application, I verify that I have read and understand the above
Bearnstow requirements and policies and hereby commit to abide by them.





Pay your balance by credit card / PayPal:

You may pay your balance by credit card through PayPal. Click the PayPal icon on the left to make your payment on Bearnstow’s secure page at PayPal. Enter the appropriate amount in the space provided, and your credit card information. (You do not have to be a PayPal member.)

Or pay by check:

Send check for your balance, payable to Bearnstow, to:

     Bearnstow
     83 Sanford Pl.
     Jersey City, NJ 07307

Return to Bearnstow Workshops