Gayatri Pariwar of Long Island


(Under the Guidance of All World Gayatri Pariwar, Shantikunj, Haridwar, India)

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2017/2018 REGISTRATION

(Already registered? Pay here)


       
First Name: Last Name:
Age::          Gender:          Grade:  (as of 9/1/2017)
Birthday: / /



Parent's Name:
Home Phone:
Address:
City:      State: NY      Zip:
Father's Occupation: Mother's Occupation:
Father's Cell Phone: Mother's Cell Phone:
Father's e-mail: Mother's e-mail:
Mother Language:
   
   



Class:


Vedic Math:


Volunteer Club:    

Music Class
(Learning Key Board - Optional with additional Fees of $135 for 18 Classes)



Emergency Contact Information

Name: Phone Number:
Family Doctor: Doctor's Phone#:
   
Allergies (nuts, dairy, etc)?




T-Shirt Size:
 
Total Fees: $200
Payment Mode:
You will be sent an e-mail notification after successful registration with instructions on how to submit payment via check or PayPal (cash is no longer accepted). Please note that payment for this registration must be made by 8/31/2017 or this registration will be cancelled automatically and the seat reserved for your child will be opened up to other applicants.
   
By clicking on the Continue button below, you hereby agree to waive and release, indemnify, hold harmless and forever discharge Gayatri Pariwar of Long Island, a non profit organization and its agents, officers, directors, affiliates, successors and assigns, from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I or my child (being registered above, and hereafter referred to as CHILD) ever had or may have, arising from or in any way related to CHILD’S participation in any of the events or activities conducted by, on the premises of, or for the benefit of, Gayatri Pariwar of Long Island and/or its affiliates, provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

 I understand and confirm that by agreeing to the above-mentioned waiver and release, the said CHILD and I have given up considerable future legal rights and signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. By checking this box, I am to providing proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law.

 I have read the rules and regulations listed here and agree that both I and CHILD will conform to them.

 

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