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INDIA TEMPLE ASSOCIATION
YOUTH Registration Form
For the year 2012-2013
(Please fill the following information legibly. One form per child)
  Registration Details   
Child's First Name
Child's Middle Name
Child's Last Name
Address :
City :
State :
Zip :
Home Phone # : -
Date of Birth:    
School Grade :
Attending Youth since :  
Does your child need ITA Bag? :   
Yes  No
Does your child need ITA T-shirt? : 
Yes  No
S M L
Is your family an ITA member? : 
Yes  No
Are the 2011/2012 Youth membership dues ($100) paid? :
Yes  No
Mode of payment? :  
Through Paypal
Father’s Name :
Mother’s Name :
Email ID:
Emergency Phone :
Signature of Parent :
Date :
Enter Code :      
 
  
 
 
The undersigned, as parent or legal guardian for the above registered child (hereinafter “Participant”) acknowledges the community, religious and philanthropic purposes of the Youth program of the India Temple Association, Inc., its affiliates and program partners (hereinafter the “ITA”).
By registering my child, the undersigned gives full permission for the child to participate in all activities conducted by the ITA. The undersigned will also ensure his/her child attends the Youth classes, group activities or excursions regularly and ON TIME and will take personal interest in what the child is taught in the class and cooperate with the teachers/volunteers. The undersigned gives the ITA full permission to publish the name and photographs of the Participants in any and all ITA literature, websites and newsletters.
In Consideration of the Participant being allowed to participate in the functions, programs and activities held by the ITA, the undersigned hereby agrees, on behalf of the Participant and his or her heirs, legal representative guests and invitees, that the Participant hereby accepts and assumes any and all risks resulting from attendance and participation at such functions and activities: the Participant hereby releases the ITA directors, officers, members, volunteers and agents from any and all claims, liability, fines or other matters arising from such attendance or participation: the Participant herby agrees to indemnify, defend and hold harmless the ITA, its officers, members, volunteers and agent from any and all claims, demands, expenses and liability, whether for personal injury, death, property damage, violations of law, or otherwise which is caused by the Participant and which in any way arises of or relates to the ITA function or activity.
Note to Non-English Speakers: This is a legal waiver of liability. By signature below you herby release ITA from any and all risks from participation in this activity. Your signature below acknowledges and confirms your full understanding of such waiver.
 
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December Community Service
 
 
 
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