Chinmaya Jersey City Balavihar Registration Form
Registration fees for 2014-2015 school year are $500 and are accepted as tax-deductible donations.
Checks can be made out to "Chinmaya Mission Tristate Centre" and be turned in during class to any BV teacher.
Parent 1 First Name *
Your answer
Parent 1 Last Name *
Your answer
Parent 2 First Name
Your answer
Parent 2 Last Name
Your answer
Children Info
Child 1 Full Name *
Your answer
Child 1 Birthdate *
Please state as MM/DD/YY
Your answer
Child 1 Grade *
Child 2 Full Name
Your answer
Child 2 Birthdate
Please state as MM/DD/YY
Your answer
Child 2 Grade
Child 3 Full Name
Your answer
Child 3 Grade
Child 3 Birthdate
Please state as MM/DD/YY
Your answer
By checking the box below, I am indicating interest in Hindi classes for my child(ren)
These classes will be held before each Balavihar session starts - 3x a month
Contact Information
House Address *
Your answer
City, State, Zipcode *
Your answer
Parent 1 Mobile Number *
Your answer
Parent 2 Mobile Number
Your answer
Parent 1 Email Address *
Your answer
Parent 2 Email Address
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number 1 *
Your answer
Emergency Contact Phone Number 2
Your answer
Available for volunteering for: *
Required
By checking the box below, I agree to follow the Balavihar participant guidelines *
Please check out http://www.chinmayavrindavan.org/guidelines.php -- especially the portion for adult responsibilities!
Required
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