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JSNE Pathshala Registration Form 08-09

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JSNE Pathshala Registration Form 08-09 Powered By Docstoc
					                                                                    Jain Sangh of New England Pathshala
                                                                               Burlington, MA




           Pathshala Registration Form for the Year September 2010 June 2011
                                       (Use one form per Family)
                        (Visit www.JSNE.ORG for Pathshala information)

Last Name of the Family: ______________________

No    Student Name           Birth       School Grade    Pathshala Level   Any Food             Attending
                             Date        as of 09/2010   __ in 2009-2010   Allergies?           Shishu Bharti?
1
2
3

(Note – Minimum age for a child to attend the Pathshala is 4 years old as of September 2010)

Mother’s Name: _______________________ Father’s Name: ____________________________

Home Address: _________________________________________________________________
             City _______________________ State ________ Zip _____________________

Tel. No. (H) ________________________                Fax No. ________________________
Cell. No. (Mom) _____________________                Cell. No. (Dad) ___________________

Email addresses:      Student: __________________________________________

Mother: ______________________________________Father: ______________________________________
(Note – The above email addresses will be added to the JSNE yahoo email group for all communications)

May we share your contact info with other JSNE Pathshala families?: -        Yes            No

Which of the Pathshala activities would you (parent) like to participate/contribute in -?
 Help Teacher  Cultural Program Choreographer  Other

Suggestions: Provide your suggestions on a separate sheet of paper regarding our Pathshala meeting
times and frequency, curriculum and teaching, and other logistics.

____________________________             __________________________                 ___/___/___
Print Full Name of Parent/Guardian        Signature of Parent/Guardian                 Date


Please complete this form and mail to:


Hemant Shah, 115 Oak Hill Dr., Sharon, MA 02067, Phone # 781-784-7098
(We would appreciate if you mail this form at your earliest to help us plan all the pathshala
activities efficiently)

				
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