Registration Form
AKalaivan Academy online class registration and waiver form.
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Email *
Student Full Name *
For minor student:  Parent / Guardian Name
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Phone *
WhatsApp Number *
Address *
Please select the class from the below list of Available Language classes:
Yes
English
French
Hindi
Spanish
Tamil
Telugu
Please select the class from the below list of Available Music classes:
Yes
Drums
Flute
Guitar
Keyboard / Piano
Violin
Veena
Carnatic Vocal
Western Vocal
Please select the class from the below list of Available classes:
Yes
Art
Adimurai & Silambam
Bollywood Dance
Chess
Rubik's Cube
Yoga
Zumba
Please select the class from the below list of Available Academic classes:
Yes
Abacus
Chemistry
Math
Python
Physics
Vedic Math
Photo Release *
I give Akalaivan academy, its agents, employees, servants, assigns, and successors, without expectation of value, permission to:  Record my child’s likeness and appearance on videotape, audiotape, film, photograph, or any other medium;  Use my child’s name, likeness, voice, and biographical material in connection with these recordings; Exhibit, copy or distribute such recording in whole or in part without restrictions or limitation for any educational or promotional purpose or advertisement campaigns which the Akalaivan Academy, and those acting pursuant to its authority, deem appropriate.
Waiver and Release of Liability *
As a participant (or parent of a minor) in the class offered by AKalaivan Academy, I understand and agree to the following terms set forth: In consideration for my child being permitted to participate in the virtual class, I, on behalf of my child, and as the natural parent and/or as the legally authorized guardian, do hereby for my child, myself, my family, heirs, personal representatives, and assigns, agree to, and hereby do, release, waive, discharge, hold harmless and indemnify, and forever defend the Akalaivan academy,  individually and collectively, its employees, servants, agents, representatives, directors, students, volunteers, and anyone acting on behalf of Akalaivan academy, from any and all liability, losses, claims, actions, suits, procedures, demands, rights, and causes of action of whatever nature, in law and equity, for any and all known or unknown, foreseen or unforeseen, bodily or personal injuries, death and permanent injury, illnesses, damage to property, or other losses, and any consequences thereof, including expenses, costs, and attorney’s fees, as may be sustained by my child or me, or any person or entity acting on my or my child’s behalf, arising out of, or in any way associated with my child’s participation in the program. I warrant I am the parent or authorized legal guardian of the participant in the program, and I warrant that I am 18 years of age or older. I have carefully reviewed, and I agree to the terms of this entire document.
Required
 E-Sign registration *
To E-Sign the registration form please enter your full name below:
A copy of your responses will be emailed to the address you provided.
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