VYANJAN Registration Form

VYANJAN welcomes YOU.

 

Name:_________________________________Birth-date:__/___/_____

 

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 allergies, physical conditions or health problems that may limit your participation in VYANJAN cooking classes:

 

 

 

 

What is your objective in joining VYANJAN?

 

 

 

 

Who should we thank for your presence at VYANJAN?

 

 

Agreement of Release and Waiver of Liability:

 

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.

 

 

 

Signature:_______________________  Date: __________________ 

 

If registering a child,

Parent’s Signature_________________  Date: __________________ .

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