JSNE Pathshala Registration Form for the Year September 2016 - June 2017
Note – A child must be in Pre-K and/or 4 years old as of September 2016 to attend the Pathshala. Adult Swathyay members are NOT required to fill out this form – this form is only for students from Pre-K to Grade 12.

(Visit www.jsne.org for Pathshala information)

Family Last Name *
Your answer
Father's First Name *
Your answer
Mother's First Name *
Your answer
1st Preferred Email Address *
Your answer
2nd Preferred Email Address
Your answer
Home Phone Number *
Your answer
1st preferred Cell Phone Number *
Your answer
2nd preferred Cell Phone Number
Your answer
Apt/House #, Street Address *
Your answer
City *
Your answer
State *
Postal/Zip Code *
Your answer
Name of Student (#1) *
Your answer
Birth Date *
MM
/
DD
/
YYYY
School Grade as of 09/2016 *
Current Pathshala Level
Sponsor (optional)
Add more student? *
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