Medha Student Registration Form
Welcome to Medha! We look forward to starting this journey with your student. Upon submission of this form you will see a confirmation message which will direct you to the payment page to pay the $50 annual student registration fee. If you need help please contact us at info@giftofhealth.us
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Email *
AGREEMENT TERMS
BY REGISTERING MY CHILD/WARD AS A MEDHA STUDENT, I hereby give consent to Sankara Healthcare Foundation to create and share media recordings ( video and audio), including photography, of my child for training and other legal purposes as determined by SHF, including but not limited to flyers, program brochures and videos.

I AGREE THAT Parents are an integral part for the success of Medha’s student-volunteer partnership. I agree to be present in the class at all times, or arrange for another adult to be present with my student if I am unable to for any reason.
Student First Name *
Student Last Name *
Student Age *
Parent Full Name *
Parent Phone Number *
Student City *
Student State *
SIGNATURE OF THE PARENT / GUARDIAN
PLEASE TYPE YOUR FULL LEGAL NAME BELOW. WITHOUT THAT, THIS REGISTRATION IS INCOMPLETE AND WILL NOT BE PROCESSED
Full Legal Name *
A copy of your responses will be emailed to the address you provided.
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