Bal-Mukund Registration - Radha Krishna Temple of Dallas
  • Father's Name*Father's Name
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  • Mother's Name*Mother's Name
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  • Email*a valid email address
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  • Address*Address
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  • City*City
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  • State*State
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  • Zip*Zip
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  • Home Phone*Home Phone
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  • Cell Phone*Cell Phone
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  • Student's Name*Student's Name
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  • Date of Birth*Date of Birth
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  • School Name*School Name
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  • Grade*Grade
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  • Enroll more students ?*More students
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  • I, as a parent commit to the following: 1. I will bring my child to Bal-Mukund sessions regularly, on time. 2. I will Facilitate and support my child to practice Character Building Values and lessons taught in class. 3. I will attend parent-teacher information sessions. Liability Disclaimer: In consideration of my child’s participation in the Children's Program program, I, the undersigned user, agree to release, indemnify, and hold harmless, on behalf of myself, my heirs, representatives, executors, administrators, and assigns HEREBY DO RELEASE, INDEMNIFY, AND HOLD HARMLESS Bal-Mukund Children's PROGRAM, its officers, agents, volunteers, employees, and sponsors Jagadguru Kripaluji Yog (hereafter collectively referred to as "Bal-Mukund") from any cause of action, claims, or demands of any nature whatsoever, including but not limited to, a claim of negligence, which I, my heirs, representatives, executors, administrators, and assigns may now have, or have in the future against Bal-Mukund, on account of personal injury, property damage, death, or accident of any kind, arising out of or in any way related to my use of the Bal-Mukund facility, whether that use is supervised or unsupervised, however the injury or damage is caused, including, but not limited to the negligence of Bal-Mukund, its officers, volunteers, agents, and employees. Note: Children whose conduct or influence creates safety or discipline problems will be asked to leave. They will not receive a refund. Bal-Mukund books are not included in classroom supply fees. I give permission for photographs taken at Bal-Mukund Children’s Program to be used for publicity purposes by Jagadguru Kripaluji Yog. By clicking on the 'Submit' button, you are agreeing to the terms mentioned above.
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  • Captchacopy the words
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