Registration Form
Deadline December 15th
First Name *
Your answer
Last Name *
Your answer
Gender *
Birthdate *
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DD
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YYYY
Age *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Phone Number *
Your answer
Emergency Contact (Name & Number) *
Your answer
Email Address *
Your answer
Mode of Transportation *
Do you need to be picked up airport/bus station/train station? *
If Yes, please write Location, Date, Time
Your answer
Date of Arrival *
MM
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DD
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YYYY
Date of Departure *
MM
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DD
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YYYY
Liability Waiver *
In consideration for being accepted by Shree Swaminarayan Mandir Loyadham for participating in Winter Workshop – 2019, we parent(s) / legal guardian(s) hereby waive and release Shree Swaminarayan Mandir Loyadham and all its volunteers from liability pertaining to the matters set forth. I expressly and willingly agree to assume complete responsibility for any risk of injury that may arise from any activity or activities held or organized during the Winter Workshop -2019. On behalf of myself, my heirs, assigns and next to kin, I waive all claims for damages, injuries and death sustained to me or my property, that I may have against the above-named Released Party relating to such activity. By this waiver, I assume any risk and takes full responsibility and waive any and all claims of personal injury, including severe bodily injury, damage to personal property and death relating to all activities associated with Shree Swaminarayan Mandir Loyadham and its volunteers, including but not limited to receiving spiritual education, recreational activities, using facility and its equipment’s on and off premises. If any injured from said activity, I will not hold Released Party responsible even if the injuries or the losses were caused by negligence on my party or the Released Party or any other party under or affiliated with the above-named Released Party. I do not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent me from participating in the above-mentioned Winter Workshop-2019, and, if required, will obtain a medical examination and clearance.
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