BAPS Jackson KDC 2025

Jay Swaminarayan Families! Join us for a sweet and exciting Kids' Diwali adventure filled with games, crafts, and stories that bring the Festival of Lights to life - Candyland themed!

IMPORTANT:

1. Please use accurate email address

2. Only one per family (option for more than 1 child included)

3. Save confirmation email (will be used during check in)

Father Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

WIll This Parent Attend the Event?*

Mother Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Will This Parent Attend the Event?*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Number of Kids Attending Event*

Child #1 Full Name *

Date of Birth*

Current Age *

Current School Grade*

Balak/Kishore or Balika/Kishori*

WAIVER OF CLAIMS AND RELEASE OF LIABILITY

PERMISSION TO USE PHOTO/VIDEO RECORDINGS

AUTHORIZATION OF MEDICAL CARE

This agreement is entered into by (or on behalf of) ______ {child1} _____

(“Participant”), in favor of Bochasanwasi Shri Akshar Purushottam Swaminarayan Sanstha - Southwest,

Inc., and affiliated organizations (“Releasee”), for participation in Kids Diwali Celebrations on

October 19, 2025 at BAPS Shri Swaminarayan Mandir in Jackson, MS (“Event”).

In return for the opportunity to participate in the Event, I sign below to give my consent to each of the

following:

RELEASE AND ACKNOWLEDGMENT

(1) There may be risks of harm or injury associated with my participation in the Event. I accept and

assume responsibility for such risks. I will take all training required and will comply with the safety

instructions, rules, and policies provided to me. I have no known physical or mental condition that restricts

my ability to participate and do what is expected of me.

(2) I release, indemnify and hold harmless Releasee (and all of its officers, directors, employees,

agents, insurers, and successors), to the extent permitted by applicable law, for any and all claims and

liabilities (including fees and costs) to persons or property caused in any manner by my conduct as a

participant.

(3) For myself, my legal representatives, my heirs, and all who claim from me, I waive and release all

rights, claims, damages, losses, and/or complaints against Releasee (and all of its officers, directors,

employees, agents, insurers, and successors) for any injury or damages arising out of the acts or omissions

of myself, Releasee, any other volunteer or participant, or any other person (including those arising as a

result of the negligence of any of the foregoing).

PERMISSION TO USE PHOTO/VIDEO RECORDINGS

(4) I understand and agree that Releasee may use photographs and/or recordings, whether video or

audio, of me taken or recorded while I am participating in the Event, and I hereby release irrevocably all

rights of any kind in such photographs and/or recordings and consent to Releasee’s perpetual worldwide

use of such photographs and/or recordings and their reproduction and distribution in all media. This release

includes any and all claims I may have, however characterized, including claims of rights of privacy and

publicity, false light, libel, defamation and copyright. I agree that Releasee may reproduce such

photographs and/or recordings and all or any part of their content in any format Releasee chooses and use

them for any purpose related to its nonprofit operations (including commercial use in promotional materials,

public relations, and advertising) as Releasee may determine, without compensation to me. I understand

that Releasee will rely on this release and that I cannot revoke, withdraw or cancel it.

AUTHORIZATION OF MEDICAL CARE

(5) I authorize any of the staff, employees, volunteers, agents and representatives of Releasee to

provide for, approve and authorize any health care at any hospital, emergency room, doctor’s office or other

institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such

health care; review and if necessary disclose the contents of any medical records; execute any consent form

required by medical, dental or other health authorities incident to the provision of medical, surgical or dental

Page 2 of 2

4656762v.1

care to me. Health care shall include but not be limited to the administration of anesthesia, X-ray

examination, performance of operations, diagnostic and other procedures.

(6) If the Participant is a minor and there is no medical emergency, the Releasee shall first use

reasonable efforts to contact the parent(s) and/or guardian(s) listed below before administering or

authorizing any treatment.

(7) Notwithstanding other provisions in this agreement, Releasee shall not have the authority to

withhold or withdraw life-sustaining procedures.

MISCELLANEOUS

(8) This agreement is intended to be as broad and inclusive as permitted by law. If any portion of this

agreement is held invalid, the balance of this agreement shall continue in full force and legal effect. This

agreement shall be construed and enforced by the laws of Mississippi.

(9) For purposes of this agreement, all references to “I”, “me”, “myself”, etc. shall, as applicable, refer

to and include any Participant who is the minor child or ward of the parent/guardian signing below, and the

provisions of this agreement shall be applicable to such Participant and govern his or her participation in

the Event.

(10) I acknowledge that the provisions of this agreement, including the waiver and release of liability,

are legally binding. I am signing it voluntarily, and with the understanding that, by doing so, I am agreeing

to waive and release legal rights. I intend that this agreement shall be enforceable in the event of any future

litigation. No oral representations or promises apart from this agreement have been made to me.

BY SIGNING THIS AGREEMENT I AM WAIVING OR RELEASING VALUABLE LEGAL

RIGHTS. I HAVE READ THIS AGREEMENT CAREFULLY BEFORE SIGNING IT.

Signature* Date*

Child #2 Full Name

Date of Birth

Current Age

Current School Grade

Balak/Kishore or Balika/Kishori

WAIVER OF CLAIMS AND RELEASE OF LIABILITY

PERMISSION TO USE PHOTO/VIDEO RECORDINGS

AUTHORIZATION OF MEDICAL CARE

This agreement is entered into by (or on behalf of) ____ {child2} ____