dharma Kids practice group registration

Child's Name *
Child's Name
Child's Birthdate *
Child's Birthdate
Mother's Name *
Mother's Name
Address *
Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Father's Name *
Father's Name
Address (if different)
Address (if different)
Home Phone (if different)
Home Phone (if different)
Cell Phone *
Cell Phone
By submitting this form electronically, in connection with my voluntary involvement in activities undertaken for and with the participation and support of KSC, a non-profit organization, I hereby agree, for myself, my heirs, assigns, executors and administrators to release and discharge KSC, its officers and directors, employees, agents and volunteers from all claims, demands and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold KSC, its officers and directors, employees, agents and volunteers harmless from any cause of action, claim or suit arising therein. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release.
Today's Date *
Today's Date