Bala Vihar®

Family Registration

Your email

Your Family Name

Mother's Full Name

Father's Full Name

Your Primary email

Your Secondary email

Primary Contact #

Secondary Contact #

Full Street Address

City

Postal Code

Province
ChooseAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Child #1 Full Name

Child #1 Grade in 2023/2024
ChoosePre SchoolJKSKGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12Grade 12+

Child #1 Birthdate

Child #2 Full Name

Child #2 Grade in 2023/2024
ChoosePre SchoolJKSKGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12Grade 12+

Child #2 Birthdate

Child #3 Full Name

Child #3 Grade in 2023/2024
ChoosePre SchoolJKSKGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12Grade 12+

Child #3 Birthdate

Health Concerns or Allergies for any student(s) above (please enter "NO" for none)

Additional comments, if any

I have read this release of Liability and Assumption of Risk Agreement, Fully understand its terms, understand that I have given up substantial rights by signing (by checking this box) it, and sign it freely and voluntarily without any inducement.
Agree

Photography Consent
I hereby give consent to Chinmaya Mission London(Canada) to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of myself or my child or children (if applicable) to use in any public media, including radio, television, internet, social media, print or in any of the organization’s or its partners’ publications, productions, or posts. I understand that the intended use of such images and information is solely for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness purposes for the organization. I hereby waive any rights or interest in the images or recordings, as contemplated in this release. I acknowledge that this consent to use images and/or recordings is being made solely for the benefit of the organization and comes without any expectation of monetary compensation or other benefit to me. To the extent that any benefit accrues or might accrue to the organization from the use of images or information, I hereby and forever waive any interest in or claim to such benefits. I hereby release and forever discharge the organization (including without limitation all corporate affiliates and officers, directors, trustees, donors, employees, agents and volunteers) from any and all claims, liability, actions, suits, demands, costs, expenses or indebtedness arising out of, related to, or in any way connected with the use of images and materials described herein, and I hereby waive all rights and interest in and to such information and materials. I further acknowledge that there is no guarantee that any or all of the participants’ images or recordings will be used in any released media. I have been informed that this authorization is voluntary and is subject to revocation at any time, except to the extent that action has been taken in reliance thereon, by notifying the organization in writing.

Agreement to above statement (consent to digital recording, use of images and social media etc..)
AgreeDisagree