Register for Balvihar Hindi Classes

STUDENT INFORMATION

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Male:     Female:
Yes:     No:
Yes:     No:

PARENT LEGAL GAURDIAN INFORMATION

IN CASE OF EMERGENCY CONTACT

(MUST BE OTHER THAN PARENTS)

PLEASE PROVIDE MINIMUM 2 NAMES IN ORDER OF PREFERENCE TO CALL IN CASE EITHER OF THE PARENT IS NOT AVAILABLE ALSO THESE AUTHORIZED PERSON(S) WILL BE ABLE TO PICK-UP OR DROP OFF YOUR CHILD FROM BAL-VIHAR.

E CONTACT 1:
E CONTACT 2:
E CONTACT 3:

PHYSICIAN MEDICAL

Photo Media Release Form for a Minor (For Participants under the age of 18)

I do here by consent to the publication of my child’s name and/or my child’s likeness (“Likeness”) for the purpose of promotion, publicity, advertising and of other manner of media by the VHPA, or any other representative authorized to act on behalf of the afore mentioned entity. Likeness shall include, but not limited to, still photographs, sound and/or video recordings, films, broadcasts, brochures, publications, reports, webpages, promotional materials or any other audio-visual, electronic, printed, tangible work in any media or format, now known or hereafter to become known, and/or reproductions of any of these. I agree that the actual material involved is and shall continue to be the property of the VHPA and that neither I nor my child shall have any rights of review or approval regarding the use of my child’s name and/or Likeness in such materials.
I hereby release and hold harmless, VHPA, Program, ECC along with their respective employees, volunteers, agents, affiliates, sponsors, or other representative from any and all claims, demands, or causes of action arising out of use of my child’s name and/or Likeness, in accordance with the terms of this release. I understand and agree that neither I, nor my child, will be compensated in any way for the use of my child’s name and/or Likeness by VHPA, Program or ECC.

Accept
PAYMENTS
EARY BIRD REGISTRATION ENDS MAY 31ST $180.00/STUDENT
REGULAR REGISTRATION ENDS AUGUST 31 $200.00/STUDENT
SIBLING DISCOUNT ENDS AUGUST 31 $180.00/STUDENT+1