Socal Tamil Kalvi 2019 - 2020 Registration: Personal Information and Medical Release Form
Dear parent, please fill this form each one of your children that will study in the Socal Tamil Kalvi.


SOCALTAMIL.ORG is a registered nonprofit 501 (C)(3) organization; EIN# 27-1167961. All donations are tax exempt.
socaltamilkalvi@gmail.com | www.socaltamil.org
Email address *
Student's Name *
First and last name
Your answer
Parent's name *
First and last name
Your answer
Parent's email *
Your answer
Parent's Mobile Phone number *
Your answer
Which center does the student study? *
What grade will the student study during the year 2019 - 2020? *
Physician Name *
Your answer
Physician Phone *
Your answer
Dentist Name
Your answer
Dentist Phone
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Employer Name (Father) *
Please enter the names of the Father's empolyer. Enter "Home maker", if not working.
Your answer
Employer Name (Mother) *
Please enter the names of the Mother's empolyer. Enter "Home maker", if not working.
Your answer
Do you know if either of your employers match a contribution for non-profit organizations? *
Waiver *
I agree
I decline
I give permission for my child to participate in the SocalTamil school program from Aug 2019 to May 2020.
I hereby release SocalTamil, its board of directors, representatives, agents and volunteers from any responsibility and liability for any illness or injury that my child may sustain during this activity.
IMPORTANT: *** I understand that I need to be present in the premises during every SocalTamil School program.***
In the event of an emergency, I hereby authorize an adult SocalTamil volunteer to take whatever emergency measures that are judged necessary for the care and protection of my child.
In the event of an emergency, I understand that my child will be transported by a local emergency unit for treatment, if deemed necessary by a SocalTamil volunteer.
In certain medical situations, the local emergency resource may be contacted prior to contacting the child’s parent or physician.
I hereby give Socal Tamil to use photographs and videos of me and my kids for posting on social media accounts and their website
I hereby acknowledge that I have read and sign-off the Disclaimer and Medical Release Form electronically
A copy of your responses will be emailed to the address you provided.
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