VYANJAN's Enrollment Form for In-Person / Online Healthy Vegetarian Cooking Classes
Please fill the form below.
Email address *
Your last name. *
If enrolling a child, please enter child's last name, otherwise say N/A (Please fill out a separate form for each child / each person in your household). *
Your first name. *
If enrolling a child, please enter child's first name, otherwise say N/A (Please fill out a separate form for each child / each person in your household). *
Participant's date of birth in mm/dd/yyyy format. (Please fill out a separate form for each child / each person in your household). *
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Participant's street address. *
Participant's city. *
Participant's state. *
Participant's zip code. *
Participant's phone number *
Name of emergency contact *
Relationship with emergency contact *
Phone number of emergency contact *
Primary physician's name *
Primary physician's number *
Please list any physical conditions / food or other allergies / health problems that may limit your participation in VYANJAN's In-person / Online healthy vegetarian cooking classes : *
What is your objective in joining VYANJAN's In-person / Online healthy vegetarian cooking classes? *
Please select all that apply. What is your preferred time for VYANJAN's In-person / Online healthy vegetarian cooking class ? Each class duration is about 2 hours (All times in Central Time Zone). You may indicate another option at the bottom, if you have a different time suggestion. *
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How did you hear about VYANJAN's In-person / Online healthy vegetarian cooking classes ? Please list the name of your relative / friend / website, etc. who directed you to this program. *
If you're a past VYANJAN, participant, please mention so. If a friend referred you, please list their name and email below for verification. If you got a direct email from VYANJAN, please list its subject and date for reference. If you saw this information on a website such as Facebook / Yelp / Google, please list the website and the link of the post below. Thank you for your attention to this.
Waiver of Liability, Affirmation, and Signature
Please read the liability waiver below, and enter your legal name underneath to indicate your agreement with the liability waiver as it appears below..
I, ____________________________________, hereby agree to the following: That I am participating in the cooking classes offered by Vidya Nahar at VYANJAN, during which I will receive information and instruction about healthy vegetarian cooking involving whole grains, spices, fruits, vegetables and dairy products. I recognize that cooking activities require physical exertion, dealing with foods that I may be allergic to, dealing with electric appliances such as stove and small appliances such as knives, which may be strenuous and may cause physical injury, and am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician regarding any allergies I may have prior to and regarding my participation in above-mentioned cooking classes at VYANJAN. In consideration of being permitted to participate in VYANJAN classes, I knowingly and voluntarily and expressly waive any claim I may have against Vidya Nahar and / or VYANJAN for injury or damages that I may sustain as a result of participating in VYANJAN classes and program. I, my heirs, and / or legal representatives forever release, waive, discharge and prospectively give up any right to institute any claim, suit or action against Vidya Nahar and / or VYANJAN for any injury or death caused by my participation in the program. My prospective waiver and release shall apply to all claims and demands or causes of action including those that may arise out of the active / passive negligence of those hereby released.I have read the above release and waiver of liability form and fully understand its contents. I voluntarily agree to the terms and conditions mentioned above.I have received and read VYANJAN’s Payment Policy and agree to abide by it. *
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Sign your full name below *
If registering a child, please enter child's full name below, otherwise say n/a (Please fill out a separate form for each child / each person in your household). *
Enter today's date *
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A copy of your responses will be emailed to the address you provided.
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