Chinmaya RDU - BalaVihar Enrollment Form

Bala Vihar Enrollment Form - 2011

NOTE - Fields with * are mandatory

Location

BalaVihar Location

Parent Information

Father's First Name:*	Father's Last Name:*
Mother's First Name:*	Mother's Last Name:*
Home Address*:
City:*	Zip:*
Father Cell:	Mother Cell:
Home Number*
Father Email:*	Mother Email:*
Emergency Contact Name (Default Father/Mother) :	Emergency Contact Number (Default: home phone/parents' cell) :

Child Information

	First Name *	Last Name *	Date of Birth	Grade (in Sept. 2011)*	Gender	Years in Bala Vihar

Registration Dues

	CMRDU Registration Fee (includes CMRDU membership dues + BalaVihar membership dues) are: ($300 Membership + $100 BalaVihar) = $400 - Family with one child ($600 Memebrship + $200 BalaVihar) = $800 - Family with two or more children
Your total: $; for family with
	By checking this box, I agree and understand that: 1. The membership fee is non-refundable once the Balavihar year begins in Sep 2011. 2. At least one parent (or a previously designated person to CM RDU as such) of Pre-K and K children who is legally responsible guardian of the child must be present for the entire duration of activity on the premises, preferably attending adult satsang. 3. Registration is complete only upon: a. Completing the registration form b. Attending Balavihar at the start of next year (exact dates will be emailed later). c. Submitting registration fee via check to: Chinmaya Mission RDU 106 Withwyndle Court Cary, NC 27518
General Information: 1. Bala Vihar classes available from Grade PreK thru Grade 12 2. Checks can be made payable to "Chinmaya Mission RDU" 3. Check the website for updates and announcements: www.chinmaya-rdu.org 4. If you have any questions, contact: • Inquires by e-mail to cmrdu1@gmail.com • Raju Sharma: 919-676-1767 • Vidya Narayanan: 919-439-0032 • Gunjjan Bansal: 919-929-2923 • Venkat Mandavilli (Treasurer) : 919-523-9926