Registration for IHA STARTALK Hindi Camp - 2018
July 10 - July 28, 2018 in Akron, Ohio
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade in Fall 2018 *
Your answer
Telephone *
Format: (XXX) XXX-XXXX OR XXX-XXX-XXXX
Your answer
Gender *
Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Zip *
Your answer
Email *
Your answer
Knowledge of Hindi - Speaking *
Low
High
Knowledge of Hindi - Understanding *
Low
High
Knowledge of Hindi - Script *
Low
High
Knowledge of Hindi - Reading *
Low
High
Health-related information, if any
Your answer
Did you attend IHA STARTALK HINDI CAMP last year *
Mother's First Name *
Your answer
Mother's Last Name *
Your answer
Mother's Cell Number *
Format: (XXX) XXX-XXXX OR XXX-XXX-XXXX
Your answer
Mother's Email *
Your answer
Father's First Name *
Your answer
Father's Last Name *
Your answer
Father's Cell Number *
Format: (XXX) XXX-XXXX OR XXX-XXX-XXXX
Your answer
Father's Email *
Your answer
Emergency Contact Number *
Format: (XXX) XXX-XXXX OR XXX-XXX-XXXX
Your answer
Emergency Contact Name *
Your answer
*
Required
Note: After filling this form,please print the completed Registration Form sent on your email, download and print the Health form and Consent form available at website (http://www.hindi-indianculturecamp.com) and send signed Registration Form, completed Health Form, Consent form & Registration fee check of $100 (payable to “IHA Ohio Hindi Summer Camp”) to: IHA Ohio Hindi Summer Camp, 203 Cheltenham Lane Munroe Falls, Ohio 44262. The registration fee is non-refundable.
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