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2018-19 School Registration (One Form per Child)
Email address *
SECTION 1- STUDENT INFORMATION
Child - Last Name *
Your answer
Child - First Name *
Your answer
Child - Date of Birth *
MM
/
DD
/
YYYY
Child - Age *
(Must be 5 years of age on September 1, 2018)
Your answer
Child - Gender *
Child - Language *
Child - Registration *
SECTION 2- PARENT/GUARDIAN INFORMATION
Father/Guardian Last Name *
Your answer
Father/Guardian First Name *
Your answer
Father/Guardian E-mail *
Your answer
Father/Guardian Cell Phone *
Your answer
Mother/Guardian Last Name *
Your answer
Mother/Guardian First Name *
Your answer
Mother/Guardian E-mail *
Your answer
Mother/Guardian Cell Phone *
Your answer
Home Phone *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
SECTION 3- VOLUNTEER PREFERENCES
Please indicate the areas of interest/expertise in order of preference. Our goal is to have an available pool of resources to help our overall efforts. Please select an activity from the following list. Many of the tasks will require multiple volunteers. Please note that it is mandatory to collectively volunteer for 20 hours in a school year per family.
Volunteer - Please select at least one category: *
Important: I, the parent or guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of Shri Sanatan Mandir School. I understand that the teachers will make every best effort to take care for my child(ren) but I will not be held responsible for any accidental injury or illness caused at the temple premises. I hereby release Shri Sanatan Mandir School organizers and teachers from any claims of liability. I also hereby grant permission to Shri Sanatan Mandir School, to take and use photographs, videos and digital images of my child(ren), myself or any member of my family, for use in news releases, educational materials, printed publications or materials, electronic publications, newsletters and websites. *
Signed By:
Your answer
SECTION 4- CHILD MEDICAL HISTORY
Physician *
Your answer
Physician's Phone *
Your answer
Dentist *
Your answer
Dentist's Phone *
Your answer
Is your child under a physician's care now? *
Has your child ever been unconscious due to an injury? Explain below. *
Has your child ever had a fracture or dislocation? Explain below. *
Has your child ever had surgery? Explain below. *
Does your child take prescription drugs? Explain below. *
Does your child have any of these allergies? Hives, Asthma, Bee Sting, or Others? Explain below. *
Does your child have any sensitivities to any drugs? Explain below. *
Does your child experience any chest pains or palpitations? *
Does your child have a recent history of fatigue or tiredness? *
Is there a history of sudden death by a family member? *
Does your child have any other physical problems or restrictions of which The School should know be aware of?
Your answer
Explanations of Previous Questions:
Your answer
Consent for medical treatment (Minor)- As the parent or guardian of the above named child/dependent, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. The care may be given under whatever conditions necessary to preserve life, limb or well-being of my child/dependent. *
Signed By:
Your answer
SECTION 5- PAYMENT INFORMATION
Make all checks payable to "Shri Sanatan Mandir" (Registration Fees: See Below)
Payment Type *
Amount ($) *
Check Number:
Your answer
Amount Paid : *
Your answer
Instructions
Payment must be received within a week of registration in order to confirm student enrollment.

*If paying by check, then mail to the following address (include child(ren)'s name in the memo.)

Make Check Payable to "Shri Sanatan Mandir"

Shri Sanatan Mandir Sunday School
PO Box 5421, 16 Jean Terrace, Parsippany, New Jersey 07054
or
Please pay in person at the temple.

*Do not mail cash. If paying by cash, please pay in person at the temple.

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