Jain Digest 1998 01 Vol 14 No 01

Author(s): Federation of JAINA
Publisher: USA Federation of JAINA

Page 28

"There is nothing more powerful than an idea. No weapon can destroy it, no power can conquer it, except the power of another idea." YOUNG MINDS (continued)
YJA Third Biennial Convention - Registration Form Name
Date of Birth Last First
Middle Gender Male Female
Parental Consent This area must be signed by the parent or legal guardian of any minor (under 18 years of age as of 7/ 2/98) participating in the Third Biennial YJA Convention, Please send this form along with the registration form and appropriate fees. One form per child is required.
Address
City
State/Province
-
Zip
the undersigned, hereby grant permission to have my child, participate in the THIRD BIENNIAL YJA CONVENTION and associated recreational programs to be held in Houston, Texas between July 2 and 5, 1998.
Email Address
Do you want to receive confirmation notice by email rather than standard mail? YES NO
I certify that I am the parent having custody or the legal guardian by court order of the said minor. 1 allege that the said minor is physically able to participate in the activity set forth herein.
Home Telephone
Work/College Telephone
Phone
Phone
For Emergency Please Contact Mother's Name (or Guardian) Father's Name (or Guardian) Houston Contact (if available)
I herein understand and agree that, in permitting my child to participate, I will be ultimately responsible for my child as the parent and guardian, and the YJA Convention Committee members will take all rea. sonable steps to provide individual care and safety for my child, but will not be ultimately responsible. YJA and its parent member organizations and volunteer workers or agents cannot assume responsibility for any injuries, damage, and/or harm that might result in the course of any activities during the convention.
Phone
Phone
Medical Information
Health Insurance Company Policy Name and Number
I hereby agree to indemnify and hold harmless and blameless Jain Society of Houston, YJA, and JAINA, its officers, employees, or agents from any and all liability from damages, loss, or injuries either to person or property, which the said minor may sustain while engaged in any activity conducted by or in connection with the Third Biennial YJA Convention including, but not limited to, transportation.
Allergies
Present Health
Any Special Needs
I further agree to reimburse or make good any loss or damage or costs JSH, YJA, and/or JAINA may have to pay if any litigation arises on account of any claim made by the said minor, or anyone in said minor's behalf, resulting directly or indirectly from said minor's participation in convention activities.
I certify that the information I have submitted on this form is true, complete, and accurate. I have filled out this form to the best of my ability and read the registration guidelines. Signature of parent or legal guardian if under 18). Date
I further authorize medical treatment for the said minor in the event of illness or injury sustained in my absence while participating in convention programs provided by YJA and its volunteer committees or their agents. In the case of injury or other activities requiring parental permission, YJA Convention coordinators, employees, and/or agents shall have au. thority to act for us in case we cannot be reached.
I understand that in case of injury, serious illness, or in extreme cases of disciplinary action, the convention chair will, if need be, send home my child by the first available transportation at my own expense.
PRE-REGISTRATION IS REQUIRED Total Enclosed: (please check one) (No credit cards or cash)
__US $225 (March 9 - April 10) __US $275 (April 11- May 11) ___US $325 (after May 11)
Print Name of Participant
Signature of Parent Having Custody or Legal Guardian
Make your checks payable to JAINA and return this form to:
YJA Convention c/o Anish Shah P.O. Box 1069 Alief, TX 77411-1069
If you have any questions concerning this form or any other registration issues, call:
Anish Shah Registration Chairperson 281/879-5516
Print Name of Parent or Legal Guardian
Date
Daytime Number
Evening Number
26/JAIN DIGEST SPRING 1998 Jain Education Intemational 2010_02