FGS San Bao Temple Meditation Class Registration Form
Time: Every Saturday, 9am - 10:15am
Fees: Open Donation

Due to the ongoing Coronavirus, all classes will be held online till further notice. Details will be provided to participants who’ve signed up.
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Email *
Applicant's Name *
Applicant's Education
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Applicant's Occupation
Applicant's Contact Number
Emergency Contact Name *
Emergency Contact Number *
Emergency Contact Relationship with Applicant *
Describe Applicant's current medical condition *
Why is the Applicant interested in Meditation?
What do the Applicant want to get from this practice?
How did the Applicant or you hear about this class?
Applicant's age *
Legal Guardian's Full Name
If applicant is under 18
Liability Release
In consideration of the risk of injury while participating in the Fo Guang Shan San Bao Temple Meditation Class and related events (hereafter known as “Meditation Class”), and as consideration for the right to participate in the Meditation Class, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Meditation Class, and do hereby release and forever discharge American Buddhist Cultural Society, Fo Guang Shan San Bao Temple, located at 1750 Van Ness Ave, San Francisco CA 94109, and their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (hereafter referred to as “ABCS and affiliates”), for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, financial or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Meditation Class, and any event related to the Meditation Class, and any act of God (such as, but not limited to fires, earthquakes, drought, volcanic eruption, hurricane, tidal waves, and floods). I agree to be responsible for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, financial or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Meditation Class, and any event related to the Meditation Class, and any act of God (such as, but not limited to fires, earthquakes, drought, volcanic eruption, hurricane, tidal waves, and floods).
Media Release and Consent Agreement
I understand that there will be usage of media during my participation of Fo Guang Shan San Bao Temple Meditation Class and related events rendered by Fo Guang Shan San Bao Temple. This agreement allows me to be recorded, photographed, and filmed during my participation.  I release all claims against ABCS and affiliates for rights, titles, and interests in all photographic images and video or audio recordings that are made by ABCS Fo Guang Shan San Bao Temple during my participation in Meditation Class events, including, but not limited to, any royalties, proceeds, or other benefits that are derived from such photographs or recordings.
Medical Release and Consent Agreement
I understand that during my participation of the Fo Guang Shan San Bao Temple Meditation Class and related events that I may injure or get injured due to unforeseen situations. I agree to not hold ABCS and affiliates responsible for medical aid rendered, and will reimburse ABCS for all hospital, medical and other expenses incurred in their care. I hereby give permission to ABCS and affiliates to provide, seek and consent to routine health care, administration of prescribed medications and emergency treatment for me/my child, as may be necessary, including but not limited to x-rays, routine tests and treatment, and/or hospitalization. I also give permission for ABCS and affiliates to arrange related transportation. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I also authorize and accept medical decisions made by ABCS and affiliates in my best interest in the event that I am incapacitated or unable to render medical decisions on my own.  In case of emergency, if no designated emergency contact can be reached, I consent to treatment under the supervision of and as deemed advisable by a physician licensed under the Medicine Practice Act pursuant to Section 25.8 of the California Civil Code.  I am waiving all claims against ABCS and affiliates for injury, accident, illness or death occurring during the Meditation Class.
Guardian's or Applicant's agreement *
By agreeing below, I acknowledge that I have read and understood the above and that I accept the conditions contained herein. I also represent with my agreement below that by agreeing on behalf of the child indicated as Applicant in this form, I am the legal guardian of the said child.
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