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									Chinmaya Mission Boston Member Registration Form
(All Fields are mandatory) Primary Member Last Name First Name M/F Cell Email Attending Satsang Last Name First Name M/F Cell Email Attending Satsang Spouse

Note: It is strongly recommended that at least one parent attends Adult Satsang while children attend Bala Vihar

Primary Address Street Address City Zip Apt # State Home Phone

Center (Andover/Metro West/Nashua) Preferred Session (AM 09:00-10:30 or PM 12:00-13:30) No. of Children attending Bala Vihar No. of Children attending Yuva Kendra No. of Children attending Language Classes Note: Please fill out the Bala Vihar forms for your children if attending Bala Vihar

Pledge Information I (we) Pledge a total of: (Suggested Donation: $480 per family for Andover; $380 for Nashua and MetroWest; make checks payable to "Chinmaya Mission Boston") Payment Method (Credit Card/Check/Cash/Other): Payment Enclosed (Yes/No): (If payment not enclosed, please email Naveen Agarwal at for payment)

For Office Use Only Member ID CMB Volunteer Name: (Please Turn Over) Member Status

Please print clearly. Please fill the form completely and include the required signature on the back.

It is Chinmaya Mission Boston’s (CMB) policy and requirement of participation by children under 18 in any of CMB activities that at least one parent (or a designated person identified to CMB as such) who is legally responsible as guardian of the child be present for the entire duration of such activity, preferably attending adult satsang. At all times, parents are responsible for the safety, custody, and care of their children both before and after the classes as well as any other activities. Parents or their designated supervising adults are also responsible for coordination of pick-up, drop off, safety, custody, and care of the children and youth for the Bala Vihar classes and other activities. CMB is not responsible or liable for any unattended or non-supervised children, and may take any participation action, including barring in future activities by such children. This policy applies equally to all other patrons or guests and their children as well. Participation in any of CMB sponsored activities is expressly conditioned on acceptance and compliance with above conditions.

Chinmaya Mission Boston has designated and authorized individuals to perform video taping, audio taping, and photography at all CMB activities - Bala Vihar classes, satsangs, festivals, stage shows, cultural and religious events, fundraisers, and all other regular/special programs. No one other than the designated and authorized representatives shall perform these tasks without prior written approval from the CMB Board. CMB retains all rights in the creative works produced as a result of such activities and may capture and archive them in various media (video, audio, photos, and other forms of digital storage such as CDs, DVDs etc.) for later use, such as brochures, websites, books, pamphlets, classroom instructions, slideshows, presentations, newsletters, newspaper articles, magazines, radio broadcast, lectures, fundraisers, and for highlighting of events, accomplishments, programs, discourses, and consistent with its charter and goals. No compensation whatsoever, either monetary or other forms, shall be provided for involvement, participation, or being present in these media. This policy applies equally to all other patrons or guests as well. Participation in any of CMB sponsored activities is expressly conditioned on acceptance of above conditions.

We, including spouse and children/youth, have read and understood CMB’s policy on: • Children & Youth Safety, Care and Custody Policy • Video Taping, Audio Taping, and Photographing Policy As parents and guardians of our children who wish to participate in CMB activities, we fully understand that we are directly responsible for compliance with these policies, which are express conditions of participation in any of CMB activities and agree to abide by them. We release any and all of our claims (direct or indirect) to any creative works resulting from our participation in CMB activities, including those from past activities that may be found in the archives of CMB or its affiliates. We also agree to indemnify, defend and hold CMB harmless for any act or omissions by CMB and its volunteers involving us to the extent permitted by law. Signed by an adult member of the family: Name: ____________________________________ Date: ____________

Signature: ____________________________________

Chinmaya Bala Vihar Registration Form

(All fields are mandatory) Primary Member Last Name First Name Last Name First Name Spouse

Child Information Last Name M/F Home Phone Birth Date Grade Learning Language Language Level (MM/DD/YY) (for school year Sept '09-'10 - Pre-K, Kindergarten, Grades 1-12) (Yes or No) (Hindi, Sanskrit, Tamil, Telugu, Kannada, Marathi)
(Beginner, Intermediate, Advanced)

First Name Email

Note: Please fill out the one Bala Vihar form for each child attending Bala Vihar. Also please note that children 5 years and above are eligible for language classes. Health Information Allergies: Emergency contact information (other than parent):

Additional Information

Bala Vihar Rules Attendance: Regularity and punctuality in attendance is required. Six consecutive absences with no advance notice to the class teacher may result in an inactive status. To resume the class, student will require re-enrollment. If you miss any class let the teacher know the reason for absence. Dress code: Indian Dress is preferred

For Office Use Only Member ID CMB Volunteer Name Member Status

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