ViNYAS Registration Form

Registration Form

ViNYAS welcomes YOU.

 

Name: ___________________________________________________

 

If registering a child, Parent’s Name: _______________________________

 

Day/Cell Phone: ___________________  Evening Phone:______________

 

Address: _________________________________________________________

 _________________________________________________________

Email: _______________________________________________________

 

Emergency Contact:

 

Name:_________________________Phone Number : _______________

 

Relationship: __________________________________________________

 

Primary Physician’s Name _______________________ Ph No __________

 

Please list any physical conditions or health problems that may limit your

Dance-participation at ViNYAS:

 

 

 

 

What is your objective in joining ViNYAS?

 

 

 

 

Who should we thank for your presence at ViNYAS?

 

 

 


 

 

Agreement of Release and Waiver of Liability:

 

I, ____________________________________, hereby agree to the following: That I am participating in the dance / aerobics classes offered by Vidya Nahar at ViNYAS, during which I will receive information and instruction about Indian folk dances, bollywood dances and general aerobics. I recognize that these activities involving dancing and aerobics require physical exertion, 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 prior to and regarding my participation in above-mentioned dance activities at ViNYAS. In consideration of being permitted to participate in ViNYAS classes, I knowingly and voluntarily and expressly waive any claim I may have against Vidya Nahar and / or ViNYAS for injury or damages that I may sustain as a result of participating in ViNYAS 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 ViNYAS 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 ViNYAS’ Payment Policy and agree to abide by it.

 

 

 

Signature:__________________________  Date: __________________ 

 

If registering a child,

Parent’s Signature: ____________________   Date: _________________ 

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