Jain Vishwa Bharati, Houston USA

Registration Form

18th Annual Family Camp
at Radha Madhav Dham, Austin, TX
Friday, March 30, 5:30 pm to Sunday, April 1, 12:00 pm

* First Name		[$125/person]
* Last Name
Address
City
State
Zip
* Phone
Alternate Phone
* Email
Additional Registrants:
Adult 2		[Add $125]
Adult 3		[Add $125]
Adult 4		[Add $125]
Total Adults
Children (age 12-17):
Child 1		[Add $50]
Child 2		[Add $50]
Children (age 2-11):
Child 3		[Add $50]
Child 4		[Add $50]
Total Children

	I/We have read and agree to the Terms and Conditions.

Terms and Conditions:
I hereby stipulate that I am physically sound to proceed with instructions in Preksha Meditation and Yoga. It is further agreed that all exercises and lessons shall be undertaken at my own risk and that Radha Madhav Dham and JVB Preksha Meditation Center shall not be liable for injuries, damages or claims to myself or my property arising out of, or connected with, the use of services or facilities of Radha Madhav Dham and JVB Preksha Meditation Center or the or the premises in which the same is located. Radha Madhav Dham and JVB Preksha Meditation Center accept no responsibility of any kind for the Meditation and Yoga activities. I do hereby release and discharge Radha Madhav Dham and JVB Preksha Meditation Center from all such causes of action.