Jain Digest 1999 07

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

Page 29

Last Name:
Address:
City:
Tel: ()
Birthdate:
"There is nothing more powerful than an idea. No weapon can destroy it, no power can conquer it, except the power of another idea."
MIDWEST REGIONAL CONVENTION
REGISTRATION FORM
"East Meets West: Tradition Vs. Comprise of Jain Values"
First Name:
School/Profession:
Graduating Year:
Parents' Names:
Diet:
Vegetarian
Medical Insurance/Policy#:
Emergency Contact:
Special Needs:
State:
Gender: Male
Email
Jain Center:
Vegan
Registration Information:
Zip:
Roommate Preference (Only one choice, optional):
Full Name:
Tel: ( ) State: Check if you would prefer not to publish any of this information in the convention souvenir booklet.
Tel:
MI:
Jain Vegetarian
Female
I hereby certify that the information submitted above if 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: 1
$150-Postmarked by August 15, 1999 Open to all youth
$175-Late Fee; postmarked by Sep. 30, 1999
Open to all youth Forms may not be accepted after September 1, 1999! Donations: $100.00 $25.00 $50.00 Other
Make checks payable to: Jain Society of Greater Detroit. (write 'YJA Midwest Convention' in the MEMO portion of the check). Mail Registration Forms and all fees and donations to: YJA Midwest Convention % Shamita Shah 37448 Windwood Dr. Farmington Hills, MI 48335
PARENTAL CONSENT FORM
This form must be signed by all participants over 18 or a legal parent or guardian of any minor (under 18 years of age as of 11/25/99) participating in the YJA Midwest Regional Convention.
I, the undersigned, hereby grant permission to have my child (one form per child is required) participate in the YJA Midwest Regional to be held in Detroit, MI between November 25 and 28, 1999. I certify that I am the parent having custody or the legal guardian by court order of the said minor. I allege that the said minor is physically able to participate in the activity set forth herein.
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 Midwest Regional Convention Committee members will take all reasonable steps to provide individual care and safety for my child, but will not be ultimately responsible. The Convention Committee and all its parent member organizations, 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.
I hereby agree to indemnify and hold harmless and blameless The Jain Society of Greater Detroit (JSGD), YJA, 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 YJA Midwest Regional Convention including, but not limited to transportation.
I further agree to reimburse or make good any loss, damage, or costs that JSGD, YJA, and JAINA may have to pay if any litigation arises on account of any claim made by the said minor, or anyone in the said minor's behalf, resulting directly or indirectly from the said minor's participation in the convention activities.
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 JSGD and its volunteer committees or their agents. In the case of injury or other activities requiring parental permission, the YJA Midwest Regional Convention Committee coordinators, employees, and/or agents shall have authority to act for me in case I cannot be reached
I understand that in case of injury, serious illness, or in extreme cases of disciplinary actions, the convention chairperson will, if need be, send hom my child by the first available transportation at my own expense. I also understand that my child may be removed and sent home if he/she attempts to leave the convention site for any reason during the convention other than for any authorized group trips that may be taken.
Signature of parent having custody or legal guardian
Daytime telephone number Evening telephone number Signature of participant
JAIN DIGEST FALL 1999/