HOME ASSEMBLY PRESENTS: MY GREATER IS COMING! SACRED ARTS DANCE LEADERSHIP CONFERENCE Pastor Stine McDonald Keynote Speaker WHEN August 10 12, 2017 *Thursday: Leaders Only 6pm 9pm Friday: 7am start ~All Night Shut In~ Saturday: 7am - 4:00pm *Culmination Program 4:30pm 6:00pm $10 Donation ~Liturgical Garments Fashion Show~ Praise & Worship, Mass Dance Selection, Anointing Prayer for Ministry Growth and Outreach in Dance Unity & Warfare WHERE Home Assembly Church 13515 S. Figueroa St. Los Angeles, CA 90061 HomeAssembly.org 310-436-6336 SEMINARS Leadership Development, Foundation building in understanding praise & worship; and teaching on function and purpose of Sacred Arts Ministry & worship instruments FEATURING Donald Whitman, Master of Ceremonies Shari Demby, Songstress/ Praise Leader Mark Henley, Pianist Conference Planners: Lisa Caleb, Maggie Whitman, and Shon Harris *EARLY BIRD* REGISTRATION TIL JULY 13TH $65 Mail or Online AGES 5 ADULT CHILDREN/TEENS/ MEN/ WOMEN GENERAL REGISTRATION TIL JULY 27 $75 Mail or Online SEMINAR SPEAKERS Elaine Norville Robin Deanne Stephanie Wright Maggie Whitman Lisa Caleb WORKSHOP INSTRUCTORS Josiah Jones: Mime Zena Owens: Sign Stephanie Wright: Flags Shon Harris/ Lisa Caleb/ Deanna Frelix: Dance WORSHIP ARTS PASTOR Elaine Norville
My Greater Is Coming! Sacred Arts Dance Leadership Conference Register Now! For August 10-12, 2017 Individual Conference Participant Registration (Includes all sessions: Seminars and Workshops, daily meals, t- shirt; and free admission to Culmination Program Individual Conference Program Early Bird Rate on or before July 13, 2017. General Registration (July 14-27, 2017) Price $65.00 $75.00 Saturday Culmination Program (Guest Tickets) August 12, 2017 4:30pm - 6:00pm $10.00 Liturgical Garments Fashion Show Praise and Worship, Mass Dance Presentation Anointing Prayer for Ministry Growth & Outreach Subtotal: Method of Payment Total: Check: Payable to Home Assembly Church Tracy Willis; Home Assembly,13515 S. Figueroa St. Los Angeles, CA 90061 Name Home Assembly PayPal Link (homeassembly.org) Click Online Giving; click Special Programs: Donate Registration amount: Add Note to Special Instructions: Sacred Phone Please call office 310-436-6336 if need of any other payment arrangements such as bringing in cash, check, or credit card payment. Signature If registering group of 5 or more, please contact office for group discount rate/ registration form. 310-436-6336
Apostolic Faith Home Assembly, Inc. PARENTAL CONSENT FORM My Greater is Coming! Sacred Arts Dance Leadership Conference 2017 I Print parent/ guardian s name, the guardian of Print minor s name/ age give consent for my child to attend My Greater is Coming! Sacred Arts Dance Leadership Conference Name of Event located at 13515 S. Figueroa Street, Los Angeles, CA 90061 City, State on August 11 12, 2017 for the General Conference Program_ Dates *Church Affiliation: Pastor: *Dance Ministry Leader, if applicable: City, State Contact: Chaperones: I understand that you advise children to be accompanied by a chaperone participant approved by me or my church group: Below is the name of the accompanying chaperones, and their contact information: Child s Chaperone 1: Name, Position: Cell Phone:( ) Email: Child s Chaperone 2: Name, Position: Cell Phone:( ) Email: *I further understand that my child will also be under the direction of Home Assembly Staff Volunteers and Guest Instructors in the training seminars, dance workshops, and event activities. Meals: Please check one : Vegetarian or Regular (Includes Two Continental Breakfast; Two Lunches on Fri/ Sat and One Dinner on Fri) Food Allergies; Please list and state allergy reaction: Medical Information or Drug Allergies (List and state reaction): Please indicate any health concerns we should be aware of: A Place to CHANGE: Come Have A New Growth Experience 13515 S. Figueroa Street www.homeassembly.org Office: 323-436-6336 Los Angeles, CA 90061 Fax: 323-436-6337
Apostolic Faith Home Assembly, Inc. ADULT PARTICIPANT CONSENT FORM (My Greater is Coming! Sacred Arts Dance Leadership Conference 2017 Event/ Activities) I, Print Name give my consent to attend and fully participate in: My Greater is Coming! Sacred Arts Dance Leadership Conference Name of Event located at 13515 S. Figueroa Street, Los Angeles, CA 90061 City, State on August 10 th, Adult Leaders Only; if applicable; or in [General Conference: August 11 12, 2017] Dates *Church Affiliation: Pastor: *Dance Ministry Leader, if applicable: City, State Contact: Meals: Please check one: Vegetarian or Regular (Includes Two Continental Breakfast and Two Lunches on Fri/ Sat; and One Dinner; Fri evening) Food Allergies: Please list and state any known allergy reaction: Medical Information or Drug Allergies (List and state reaction): Please indicate any health concerns we should be aware of: EMERGENCY CONTACTS: Name of Contact 1: Home Phone:( ) Mobile ( ) Name of Contact 2: Home Phone:( ) Mobile ( ) In the event of an emergency I,, understand that Home Assembly Staff will respond with immediate First Aid / CPR if needed; and contact 911 as indicated in the event that I become unconscious and/ or sustain a life-threatening injury or condition. I further understand that in the event of an emergency involving my person, every attempt will be made to notify my emergency contacts, as soon as possible. Please refer to Release of Liability Form. Please sign below: Participant s signature: Date: A Place to CHANGE: Come Have A New Growth Experience 13515 S. Figueroa Street www.homeassembly.org Office: 323-436-6336 Los Angeles, CA 90061 Fax: 323-436-6337
Apostolic Faith Home Assembly, Inc. EVENT INFORMATION EVENT INFORMATION: Morning Seminars/Afternoon Workshops; Friday Night Shut In ; Saturday Afternoon Culmination Program; Items to bring: Sleeping Bag or Blanket/ Pillow; Backpack or Duffle Bag (Please only one bag to hold all personal belongings; please label) Toiletries: (toothbrush/ tooth paste, mouthwash, disposable face/ hand wipes; soap/ facecloth in Ziploc bag, lotion, deodorant, personal hygiene items) Hairbrush/ comb, hair moisturizers, head scarves (optional) Full length pajamas pants/ pajama tops (short or long sleeve); requested for men, women, boys and girls. Slippers/ socks to keep feet warm Comfortable clothing/ shoes for both days: Saturday Change; No shorts or sleeveless tanks or tops please! Appropriate practice attire: Capri pants, sweats, leggings, jazz or palazzo pants; short or long sleeve t- shirts or leotard; please wear support underwear/ unitards, as needed: please no sleeveless t-shirts or shorts (Home ministry T-shirt) Saturday Uniform for Mass Dance Presentation: Men/ Boys: Unisex: Black palazzo, jazz pants; or comfortable black slacks or pants; Women/ Girls: appropriate undergarments, unitards/ tights/ leggings; and sports bra (if applicable); everyone black jazz shoes or comfortable black dance shoes; (No jeans or tight-fitting pants); (Conference T-shirt included for all pre-paid participants). CONFERENCE T-SHIRT: Please indicate size: Adult: Sm Med Lrg X-Lg 1X 2X 3X or 4X *Important: Current Leaders or those appointed in leadership training, please indicate yes if you will be attending the Leader s Session as this is a limited session. Thursday night Closed Leader s only Session Yes I will be attending Or No ; I will be attending the General Conference Only (Fri/ Sat). Please confirm, Thank you. Leader s Only, please indicate if you would like to sell (5 10 tickets); $10 each to your family/ friends to attend the Culmination Program on Saturday afternoon; 4:30pm 6:00pm (Additional program details forthcoming!) Please Check : Yes, interested in selling tickets, or No, thank you. *Please inform us if your Pastor/ Church would like to help us co-sponsor this event with a donation of $100 or more. (We will gladly include your church logo as a program sponsor) RESPONSIBLE ORGANIZATION Apostolic Faith Home Assembly, Inc. 13515 S. Figueroa Street Los Angeles, CA 90061 Office: 310-436-6336 Fax: 310-436-6337 HomeAssembly.org Maggie Whitman, Sacred Arts Director: magdalenewhitman@icloud.com)
Please list any medications that your child must take during the conference hours: Medication: Dose: Frequency: Medication: Dose: Frequency: *Please label with child's name and include in original container enclosed in a Ziploc bag. EMERGENCY CONTACTS: Name of Contact 1: Relation to Minor: Home Phone:( ) Mobile ( ) Name of Contact 2: Relation to Minor: Home Phone:( ) Mobile ( ) In the event of an actual emergency, I, allow the above-named chaperones to act as guardian to make the appropriate decision on my behalf should my child require immediate medical attention. I further understand that in the event of an emergency involving my child, every attempt will be made to notify me as soon as possible. Please sign below. Parent/ Guardian signature: Date: Apostolic Faith Home Assembly, Inc. EVENT INFORMATION EVENT INFORMATION: Day Seminars/ Workshops; Friday Night Shut In ; Saturday Afternoon Culmination Program: Items to bring: Sleeping Bag or Blanket/ Pillow; Backpack or Duffle Bag (Please only one bag to hold all personal belongings; please label) Toiletries: (toothbrush/ tooth paste, mouthwash, disposable face/ hand wipes; soap/ facecloth in Ziploc bag, lotion, deodorant, personal hygiene items) Hairbrush/ comb, hair moisturizers, head scarves (optional) Full length pajamas pants/ pajama tops (short or long sleeve); requested for men, women, boys and girls. Slippers/ socks to keep feet warm Comfortable clothing/ shoes for both days: Saturday Change; No shorts or sleeveless tanks or tops please! Appropriate practice attire: Capri pants, sweats, leggings, jazz or palazzo pants; short or long sleeve t- shirts or leotard; please wear support underwear/ unitards, as needed: please no sleeveless t-shirts or shorts (Home ministry T-shirt) Saturday Uniform for Mass Dance Presentation: Men/ Boys: Unisex: Black palazzo, jazz pants; or comfortable black slacks or pants; Women/ Girls: appropriate undergarments, unitards/ tights/ leggings; and sports bra (if applicable); everyone black jazz shoes or comfortable black dance shoes; (No jeans or tight-fitting pants); (Conference T-shirt included for all pre-paid participants) CONFERENCE T-SHIRTS Please indicate Child/ Youth Size: C. SM C. Med C. Lrg Y. XL Y XXL RESPONSIBLE ORGANIZATION Apostolic Faith Home Assembly, Inc. 13515 S. Figueroa Street Los Angeles, CA 900612 Office: 310-436-6336 Fax: 310-436-6337 HomeAssembly.org Maggie Whitman, Director: magdalenewhitman@icloud.com)
APOSTOLIC FAITH HOME ASSEMBLY, INC. District Elder Marcus Jackson, Senior Pastor SACRED ARTS MINISTRY AGREEMENT AND RELEASE OF LIABILITY 1. In consideration of being allowed to participate in activities, programs and classes presented by Apostolic Faith Home Assembly, Inc. (AFHA), and to use facilities and equipment included with these sessions, I do hereby waive, release and discharge all Instructors/ Guest Instructors, Workshop Leaders, Speakers, and Facilitators affiliated with (AFHA) and its officers, agents, employees, representatives, executors and all others from any and all responsibilities or liabilities from injuries or damages resulting from my participation in any activities, or my use of equipment in the above mentioned activities. I do also hereby release all of those mentioned, and any others acting upon their behalf from any responsibility or liability for any of those mentioned or others action on their behalf, or in any way arising out of or connected with my participation in any activities of Instructors/ Facilitators or Staff of AFHA or the use of any equipment associated with said activities. Please Initial 2. I understand and am aware that exercise actvities, including the use of equipment, is a potentially hazardous activity. I also understand that these activities involve a risk of injury and even death, and that I am voluntarily participating in these activities and using equipment with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death. Please Initial 3. I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment except as hereinafter stated. I do hereby acknowledge that I have been informed to consult my physician s approval for my participation in any new physical activities pertaining to workshops/ classes and activities hosted by Apostolic Faith Home Assembly, Inc. Please Initial 4. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with a physician about physical and training activities so that I might have his/her recommendations concerning activities and equipment use. Please Initial 5. I acknowledge that I have either had a physical examination and been giving permission to participate in physical activity and use of equipment by a physician, or that I have decided to participate in activity and equipment use without the approval of a physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment in my activities. Please Initial Minor Participant Print Name Minor s Parent or Guardian s Signature (If participant is under 18 years of age) Adult Participant Print Name Participant signature Date 13515 S. Figueroa Street www.homeassembly.org Office: 310-436-6336 Los Angeles, CA 90061 Fax: 310-436-6337
My Greater Is Coming! Sacred Arts Leadership Conference Church Group Sign Up List- Special Reduced Rate $60 per person August 10 th Leader s Only Session; August 11 & 12, 2017-General Conference- Church Name/ : Pastor Name: Phone: Co-Sponsor: $100 or more $ Donation: $ Total Participants# Total Amount: $ Participant s Name Email Phone Consent Forms Liability Release Paid 1. 2. 3. 4. 5. 6. 7. 8. Please make payable: Home Assembly Church (Memo: SAM. Conf.) : 13515 S. Figueroa St. Los Angeles, CA 90061 For Questions/ More Information: Please email: magdalenewhitman@icloud.com or call Church Office: 310-436-6336 Page 1 of 2
Participant s Name Email Phone Consent Forms Liability Release Paid 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Please make payable: Home Assembly Church (Memo: SAM. Conf.) : 13515 S. Figueroa St. Los Angeles, CA 90061 For Questions/ More Information: Please email: magdalenewhitman@icloud.com or call Church Office: 310-436-6336 Page 2 of 2