For Ulchemy Registration form for Ulchemy Program. Kindly make payment before submitting this form Your Name How would you like be called (Nick Name) Sex Male Female Others Date of Birth Age Mobile Your Email Address Occupation Program Date Venue/City How did you come to know about this program? What motivated you to attend this program. Or.. What do you expect from this program? Have you attend any such program...? if so... mention the name Payment Information (Date and Mode of Payment, Transaction Ref. No etc) Tell us about Your a) Nature : b) Interest : c) Dreams / Desire : d) Achievements : AGREEMENT I acknowledge that Dakshina Foundation will provide “Ulchemy” classes requiring both physical and mental exertion on my behalf. I will at all times act within my own level of confort. Taking particular care of my injury or complaint that I carry when participating . I acknowledge that Ulchemy Program contains both physical and dynamic practice that requires both mental and physical focus in order to avoid potential injury, and that injury and soreness are a real and material risk in every class. I will always keep Dakshina Foundation informed of my comfort levels and will immediately cease any acrivity if I become uncomfortable with my condition. I acknowledge that Dakshina foundation is providing guidance based on the experience and education of its teachers, and no way do they claim to be medical and practitioners. It is my responsibility to decide or not to follow the advice and guidance given by Dakshina foundation, and in no way do I hold Dakshina foundation responsible for any injury or soreness acquired while undertaking the practices taught iin the Ulchemy program. I hereby commit that the information that I have provided is accurate and fully reveals the nature of my state of health as of the date of this document. In addition I undertake to continuously inform Dakshina foundation of any changes to my health status whilst attending the Ulchemy Program. I, agree to the statement above and I am fully responsible for any consequences and willing to compensate any loss or damage caused to the organization.