Parent Information


Father's First Name*
Father's Last Name*
Father's WhatsApp
Father's E-mail:*
Mother's First Name*
Mother's Last Name*
Mother's WhatsApp
Mother's E-mail:*
Volunteering?
Interested in Yoga?
Web Development?

Contact Information


Primary Phone #*
Address:*

First Child Information


First Name-1
Last Name-1
Age-1*
Gender-1*
Grade - Child 1*
Language-1

Second Child Information


First Name-2
Last Name-2
Age-2
Gender-2
Grade - Child 2*
Language-2

Third Child Information


First Name-3
Last Name-3
Age-3
Gender-3
Grade - Child 3*
Language-3

Payment Information


We are requesting $600 as the annual family Bala Vihar membership. You can make payment by cash or check when picking up your books.

Check should be made payable to "Chinmaya  Mission Tri-state Center" or "CMTC".

Payment Mode:
Amount
Check No*
Check Date:
Bank Name*

Returning Member ?


Liability Release:


I agree to assume all the risks of attendance and participation for my family, including my children and hereby release, waive, and forever discharge any and all liability, claims and demands against Chinmaya Sudarshan, CMTC, its agents and other affiliated parties.I further acknowledge and understand that participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. I assume the risk and hereby release and forever discharge Chinmaya Sudarshan, CMTC, its agents and affiliated parties from any claim whatsoever which arises or may hereafter arise.*
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