Membership Information
New/Returning (Choose One)
Enrollment Type (Choose One)
New Member
Existing Member
Family ($400/year)
Single ($300/year)
Parents Information
First Name
Last Name
Email Address
Mobile Phone
(xxx-xxx-xxxx)
Mr.
Mrs.
Address
Apt #
City
State
Zip
Home Phone
(XXX-XXX-XXXX)
Student's Information
First Name
Last Name
Date of Birth
(MM/DD/YYYY)
Grade At School
Email Address
Choose
0-Prek
PreK
KG
1
2
3
4
5
6
7
8
9
10
11
12
Choose
0-Prek
PreK
KG
1
2
3
4
5
6
7
8
9
10
11
12
Choose
0-Prek
PreK
KG
1
2
3
4
5
6
7
8
9
10
11
12
Magazine Subscription
(Choose One - Included in Membership)
Balavihar (through Grade 7)
Chinmaya Udgosh (Grade 8+)
Tapovan Prasad (Adults)
Mananam (Adults)
Additional Subscriptions
Balavihar ($35 / year)
Chinmaya Udgosh ($35 / year)
Tapovan Prasad ($25 / year)
Mananam ($25 / year)
Payment Type (Choose One)
Cash / Check
PayPal
Facility Use
Chinmaya Mission Portland rents the MJCC facilities for use for the times indicated above. Except for these designated places, CMP members must refrain from wandering around or using other parts of the facility. CMP is not liable for anything outside the confines of the area we rent.
Parents and students must wear the Chinmaya Mission Portland badge for identification purposes
Beyond using the MJCC lobby for entry/exit and the designated rooms all other areas are out of bounds.
The MJCC café seating area is only for the customers who have purchased food/drink for consumption on-site.
For those parents who are not participating in adult study group, you can either sit in the back of the auditorium till the Bala Vihar class is over or leave the facility and come back at 10:45 AM to pick-up. If you are going to leave the facility, please ensure you have one adult responsible for your children in case of emergency.
Parents participating in the yoga class are expected to make their own arrangements for care of their children during class as there are no CMP volunteers to baby-sit.
In consideration of your acceptance of my family’s participation in the above program,
Please initial that you have read the notes regarding the Facility Use and agree to comply with it.
If you are registering for the first time, please give us name of the person whom we can thank for the referral. If you have found out about CMP through other means(websearch, posters, etc) please enter that information here:
Waiver and Release
In consideration of your acceptance of my family’s participation in the above program, I hereby, for myself and my family, waive and release Chinmaya Mission and their officers, trustees, volunteers and members, and all other persons participating in the program, or involved in planning or execution of the program, from all liability or claims arising from any injury to myself, my child or my property. This release shall include, without limitation, all claims for negligence, and shall exclude only claims for willful injury, which exclusion for willful shall extend only to the person committing willful injury and not to any other person released hereby. I hereby give permission for my family to have their picture taken while participating in activities associated with Chinmaya Mission. Said pictures become the sole property of Chinmaya Mission and will be used only for recruiting/information-sharing purposes.
Signature (type your name here):
©2012 Chinmaya Mission Portland
