Chinmaya Mission Orlando

Chinmaya Mission Orlando

To give maximum happiness to maximum people for maximum time

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My Bala Vihar

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7th Annual Devi Retreat

Divya Shakti

Registration Form

Registrant 1 Full Name

Registrant 1 Date of Birth

Address

Phone

Would you prefer to stay with a host family?

Yes

Maybe

Will you need transportation from and to the airport?

Yes

Maybe

Emergency Contact Name

Emergency Contact Phone

Please specify any allergies related to each registrant

Payment Options

Check ( Must be received by mail to reserve spot, payable to "CMO")

Card

Must be received by mail to reserve spot, payable to CMO and mail to Chinmaya Mission of Orlando Inc., PO Box 14046,Orlando FL 32814.

Release / Indemnification

I hereby consent to the above listed participation and release absolutely, discharge, hold harmless and covenant not to sue Chinmaya Mission of Orlando, Inc. (CMO), and its directors, committee members, volunteers, and affiliates from any and all present or future liability, claims, demands, actions or rights of action, whether asserted by me or a third party arising out of my (or my child's) participation in CMO's activities("Claims"). I agree to indemnify and hold harmless CMO for any such Claims brought by me or a third party from any costs associated with defending or litigating such claims, including but not limited to attorney fees, costs and legal expenses. Medical Emergency. I understand that every effort will be made to contact the parent/contact listed above in case of illness or emergency, prior to the administration of any medical service. I hereby authorize CMO administrators and on-duty volunteers to render first aid for illness or injury to my child and to use their best judgment to secure the medical attention they deem necessary for the health and safety of my child, including transporting him/her to the nearest available hospital/emergency care centre for emergency medical or surgical treatment. I further authorize the release of the above medical information to all medical personnel providing treatment. I agree to be solely responsible for the payment of all expenses incurred in such an emergency. Photos/Videos. I hereby permit CMO to use, in whole or in part, photographs, videos, written extractions, and voice recordings of me or my child for the purpose of posting on the website, illustrations and publications. I will separately notify CMO in writing if I do not wish to permit this. Parent/Guardian: I hereby affirm that I am the parent and/or legal guardian of the children registered above (if any)

I Agree to the terms and conditions

Security Check

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