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2019 Dharma School for Kids & Youth Registration Form
Email address *
CLASS CHOICE
Dharma School for Kids
Dharma School for Youth
Basic Info
1) Child's Name *
Your answer
2) Gender *
3) Date of Birth *
MM
/
DD
/
YYYY
4a) Does child have ANY allergies or medical restrictions? *
4b) If yes, please provide details of allergies and/or medical restrictions.
Your answer
Contact Info
5) Parent/Guardian's Name *
Your answer
6) Contact Number(s) *
Your answer
7a) Parent's Email *
Your answer
7b) Student's Email *
Your answer
8a) Emergency Contact Person(s) *
Your answer
8b) Emergency Contact Number(s) *
Your answer
GUARDIAN WAIVER AND RELEASE OF LIABILITY FORM
9) INTERNATIONAL BUDDHIST PROGRESS SOCIETY GUARDIAN WAIVER AND RELEASE OF LIABILITY FORM: I, [Parent/Guardian’s Name], hereby request that my child/ward, [Participating Child’s Name], be permitted to participate in the “Dharma School for Kids Class & Dharma School for Youth Class” (Class), organized by International Buddhist Progress Society (I.B.P.S./Fo Guang Shan Hsi Lai Temple).
I hereby confirm that I have been informed of and understand the physical requirements of the Class, and that to the best of my knowledge, my child/ward has no health-related reasons or problems which preclude his participation in all activities. I understand that no special accommodations will be made for him if he is unable to perform the activities. I claim any and all responsibility and will not hold the organizer or its staff or volunteers liable should any injury or illness occur to my child/ward due to any undisclosed or pre-existing sickness my child/ward may have.
I further understand the rules and directions set forth by the organizer of the Class and hereby give my full consent to its application on my child/ward. Should my child/ward fail to follow such rules and directions, I will agree to the organizer's decision to ask my child/ward to leave the Class.
If medical care is required, I authorize the organizer and its staff and volunteers to exercise its best efforts to render medical aid, and I will be fully responsible for the charges and will reimburse the organizer for any and all hospital, medical and other expenses incurred. In the case of an emergency, I authorize the organizer to take any reasonable immediate action in their best efforts and also notify the person listed on the emergency contact.
I hereby waive, release and discharge all claims against the organizer and its staff and volunteers from any and all liability arising from the negligence or fault of the organizer and its staff and volunteers for any injury, accident, illness, death, property damage or property theft of any kind which may occur to my child/ward during the event.
9a) Child's Name - Waiver & Liability Consent *
Your answer
9b) Parent/Guardian's E-signature & Date : Waiver & Liability Consent *
By typing your name here, it indicates that you have fully read, understand, and agree to the terms of the above "Waiver and Release of Liability Form."
Your answer
MEDIA POLICY AGREEMENT
10) INTERNATIONAL BUDDHIST PROGRESS SOCIETY MEDIA POLICY AGREEMENT: International Buddhist Progress Society (I.B.P.S./Fo Guang Shan Hsi Lai Temple) reserves the right to take photographs, images, video, or audio recordings of any and all classes and activities during the event for temple records, website and future publications.
10a) Child's Name - Media Agreement *
Your answer
10b) Parent/Guardian's E-signature & Date - Media Agreement *
By typing your name here, it indicates that you have fully read, understand, and agree to the terms of the above "Media Policy Agreement."
Your answer
11) Any questions, comments, or concerns?
Your answer
A copy of your responses will be emailed to the address you provided.
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