Please fill out one registration form per family. Primary Contact:First Name *Last Name *Email Address * Adult Registration:How many adults (18+ yrs) would you like to register today?01234 Adult 1:First Name *Last Name *Email Address *What type of adult class would you like to register for? *IntroAdvancedOther (i.e. teaching, weekday class attendee etc)Adult 2:First Name *Last Name *Email Address *What type of adult class would you like to register for? *IntroAdvancedOther (i.e. teaching, weekday class attendee etc)Adult 3:First Name *Last Name *Email Address *What type of adult class would you like to register for? *IntroAdvancedOther (i.e. teaching, weekday class attendee etc)Adult 4:First Name *Last Name *Email Address *What type of adult class would you like to register for? *IntroAdvancedOther (i.e. teaching, weekday class attendee etc)Child Registration:How many children would you like to register?01234Child 1:First Name *Last Name *Email Address *What grade is this child in?JKSK123456789101112What is the age of this child?Child 2:First Name *Last Name *Email Address *What grade is this child in?JKSK123456789101112What is the age of this child?Child 3:First Name *Last Name *Email Address *What grade is this child in?JKSK123456789101112What is the age of this child?Child 4:First Name *Last Name *Email Address *What grade is this child in?JKSK123456789101112What is the age of this child?Address Information for Tax Receipts:Street Address *City *Postal Code *Home Phone *Cell PhoneChinmaya Balvihar Magazine Subscription (CAN $55, One Year)Chinmaya Balvihar magazine is a monthly publication that helps children bridge modern life and Indian values, culture and scriptures through inspiring, contemporary stories, games and activities.Yes, for $55/year please mail me the monthly subscriptionAnnual Registration Fees (Per Family)Additional donation (we sincerely request your support)*Tax receipts will be issued for the annual registration and donationsTotal-FeesTotal: $Please send an e-transfer to: cmottawa.mail@gmail.com and indicate in the "Message" section of the e-transfer that the sum is for "Bala Vihar" and include your FULL NAME (as filled in this form) I agree to all the terms mentioned belowWAIVER AND RELEASE: I agree that if my dependent or I (heretofore known as "we") engage in any physical activity, class, or activity, or facility on the premises or any venue where we participate as a representative of the Chinmaya Mission Ottawa (CMO), we do so at our own risk. I agree that we are voluntarily participating in activities and use of said facilities, premises (including the parking lot) and designated CMO venues. We assume all risk of injury, illness, damage, or loss to us or our personal property that might result, including, without limitation, any loss or theft of any personal property. I agree that this consent and assumption of risk statement covers each and every event or activity sponsored by CMO. I agree to release and discharge CMO (and its affiliates, employees, assistants, volunteers, agents, representatives, successors, and assigns) from any and all claims or cause of action (known or unknown) arising out of CMO activities. I acknowledge that I have carefully read this Waiver and Release and fully understand that it is a release of liability. PHOTO RELEASE: Chinmaya Mission Ottawa (CMO) may include photos of students, teachers, and activities on its website and printed materials. I understand that these pictures will be accessible to anyone with internet access. I give my permission for CMO to use photos of my child/children on its website, on social media, in printed materials, and in electronic forms of communication. I understand that if I do not want images of my child to be used, I will indicate this in writing and the signed letter will be attached to this document. MEDICAL RELEASE: I give my permission for the Chinmaya Mission Ottawa to transport, or call an ambulance, to take my child to a medical/dental facility, if necessary. In case of emergency, if none of the emergency contacts respond, I hereby give my consent for emergency medical care to be prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent. I accept full responsibility for all costs of said medical care and any emergency treatments. CMO will not be held responsible for the cost of any medical or dental care, or emergency treatments. I hereby waive all claims whatsoever in connection with such medical treatments. DECLARATION: By hand or electronically signing below, I confirm that I have read the document in its entirety. I understand the document, have had an opportunity to ask questions, and agree to be bound by its terms.Questions and General Information E-mail: chinmaya.bharati.ottawa@gmail.comSubmit
