Hindu Swayamsevak Sangh U.S.A., Inc.

Southwest Region

 Personal and Parental Consent, Release, and Waiver Form

Please identify each child below

Child1 Name                                                                                                                                         

Child2 Name                                                                                                                                         

Child3 Name                                                                                                                                         

Mother’s Name                                                               Father’s Name                                                 

Street Address                                                                                                                                     

Email Address                                                                                                                                      

Home Phone                                                                 Other Phone                                                    

1. As the legal parent or guardian of each child identified above, and on my own behalf, I hereby consent to such child’s and my participation in the Family Camp (“the Event”), a program conducted by the Southwest Region of Hindu Swayamsevak Sangh U.S.A., Inc. (“HSS”), from Friday, March 7, 2014 to Sunday, March 9, 2014, at Camp Woodmen located at 5193 Hwy 36 North, Bellville, TX 77418.

1. As the legal parent or guardian of each child identified above, and on my own behalf, I hereby acknowledge that such child’s and my participation in the Event will include participation in athletic activities, such as sports and yogasanas, and that participation in such athletic activities may expose such child and me to the risk of bodily injury.  Accordingly, I hereby further acknowledge that I have given my consent to such child’s and my participation in the Event having assumed the risk of bodily injury to such child and to me.

1. As the legal parent or guardian of each child identified above, and on my own behalf, in the event that such child suffers or I suffer bodily injury while participating in the Event, I hereby authorize HSS and its officers, directors, representatives, agents, and volunteers present at the Event to authorize any emergency medical or surgical treatment deemed to be in the best interest of such child or me if I am unavailable or otherwise unable to do so. I hereby further agree to assume full responsibility for the payment of all fees and expenses incurred for any such emergency medical or surgical treatment so received by such child or me.  The following insurance policy or coverage is available to cover the cost of all fees and expenses incurred for any such emergency medical or surgical treatment so received by such child or me:

                                    Ins. Co.                                                                                    

                                    Policy No.                                                                                

1. As the legal parent or guardian of each child identified above, and on my own behalf, I hereby agree to RELEASE, INDEMNIFY, AND HOLD HARMLESS HSS and its officers, directors, representatives, agents, and volunteers (“the Indemnified Parties”) from all claims for damages or injunctive relief resulting from such child’s and my participation in the Event, including any claim alleging that damages or injuries were caused by the NEGLIGENCE of any of the Indemnified Parties.

Legal Parent or Guardian Signature                                             Date

Legal Parent or Guardian Signature                                             Date

Namaste!,

As many of you are aware about the family camp & Yuva Sangam at Bellville from March 7th (7 PM) thru March 9th (11 AM) thru Madhukar ji’s email. Please find few of the details of the exciting and fun filled family camp in the attached flier. Since we have many exciting events planned for the family camp, it would be helpful to coordinate if you can register as soon as possible. Please invite your friends as they can be part of the events planned for the family camp /Yuva Sangam @ Bellville.

Your registration shulka (fee) and filled waiver form (attached to this email) to be given to your Karyavah or assigned person in your shakha to avoid the money handling or collecting forms during family camp. Checks are preferred mode of payment (Payable to HSS). More details will be communicated through your Shakha Karyavah. Yuva Sangam is for those Kishors who are going to Universities in the next year thru those who are about to begin working. Please contact Niyati ji if you have questions about Yuva Sangam.

If you have any questions please free to send an email or give one of us a call to clarify your doubts.

Dhanyavad,
Sameer » 832-538-9779  / Samba » 713-569-6469