JAIN CENTER OF SOUTHERN CALIFORNIA
Registration Form for Children’s Classes 2009 - 2010
Please complete the form and mail to: Narendra Jain, 3310 Torrance Blvd, Torrance, CA 90503
For more information call Sailes Jain at 714 529 5874
The Registration form shall include a check for $60.00. ($75.00 after June 21, 2009 and $100 after September 10, 2009) (Checks only, No cash Please).
(Please make check payable to: Jain Center of Southern California - for JCYC) First day of classes is Sunday, September 13, 2009 at 10:00 AM.
Student First: Last:
Parent Father (first name only) Mother (first name only)
Birth Date: (MM/DD/YYYY) Age: Gender:
(M / F)
Phone Home Work Cell (Important)
Numbers ( ) ( ) ( )
City: State: Zip:
Select the language class for the child (only age 7 and older): Gujarati Hindi
Special Sutra Classes are conducted 12:30 to 1:30 PM. Do you want to enroll in the Classes? Yes No
Emergency Name: (Different from Parent) Home #: Cell #:
Contact: ( ) ( )
Name of Medical Insurance: Phone #:
Name of insurance holder: Group #: Policy #:
Does child has any allergies or other medical Condition that may require special attention?
Is your child taking any medication?
Pathshala Dates are:
(Year 2009) Sep 13, 20, Oct 11, 25, Nov 8, 22, Dec 6, 20 (Winter Camp Dec 26, 27 & 28)
(Year 2010) Jan 3, 17, 31 Feb 7, 21, Mar 7, 21, Apr 4, 18, May 2, 16, Jun 6, 13 (Graduation Garba Sat, May 22, 2010)
Copy / Security Duty: From the Pathshala dates above, please indicate 4 dates (in order of preference).You will be assigned
one day on a first come first serve basis. The assignment runs from 9:35AM until 12:45PM on the day chosen/assigned of
Pathshala. Please arrive on the second floor of the post office building by 9:35AM.
Preference-1 Preference-2 Preference-3 Preference-4
We consent to the participation of our above named child in the field trips and outdoor/indoor activities, including the winter
camp. They will be under the guidance of JCYC adults. We grant permission for our child to receive medical treatment if it
becomes necessary. We also agree to the release of medical information from such doctors, hospitals or other health care
agencies where our child has received medical care,
We give our consent to provide any medical treatment to our child that may be necessary during a JCYC scheduled field trip
and outdoor/indoor activity. This includes, but is not limited to surgery and anesthetics, without our specific consent, when in
a physician’s judgment a delay caused by obtaining or attempting to obtain our consent would increase the risk to the child’s
life or the health.
We hereby release the Jain Center of Southern California, its officers, volunteers and agents from any liabilities for any
accidents or injuries that my child may incur attending the field trips, and activities at the Jain Center.
Parents’ Signatures: _______________________________ ____________________________________
Date: _________________________________ ___________________________________
(Both parents must sign)
A JCYC perspective of Jain Center
Prior to construction of Jain Center in 1988 approximately fifty students attended Pathshala. A year latter enrollment in
Pathshala classes jumped to seventy taught by three teachers. Last year a record number of 365 students enrolled in
Pathshala, largest in America. A volunteer staff of 57 teachers and ten administrative help run the Pathshala. The curriculum
has been expanded to include classes on Jainism, Indian History and Culture, and Gujarati and Hindi languages for the
children and youth. We have Swadhyay and English language classes for adults. We are the best in the nation.
JCYC is one of the biggest measures of success of our Jain Center and the major benefactor. JCYC classes use the facility year
around. Having Main building and Post Office building has contributed to its success. Many Pathshala in America are
struggling because they don’t have facilities to hold classes. We have out-grown our present facility. Cramped premises and
lack of space hinder further growth and introduction of new activities. Additional space in our new building will allow us to
organize better and improve the classes.
A "wish list" that was compiled from the member's input overwhelmingly identified that we need to expand the Derasar but
keep it in its present location. It also suggested that we build a large meeting hall, a larger kitchen, dinning hall, library and
more rooms for Pathshala, Swadhyay and Aradhana activities.
There is a price we have to pay in the form of effort and money, but the opportunity it provides to build our children's character
and future is priceless. It is beyond our imagination where our children would be without the Jain Center. Our children and our
aged parents benefit from the existence of the Jain Center.
We believe you all share the sentiment of the JCYC's success and would not hesitate to commit financially and otherwise.
Please show your support by making generous contribution, and encourage others to make such commitment.
Please select one from the following choices to help bring this dream to reality.
$ 3,000 every year for next three years
$ 2,000 every year for next five years
$ ________ every year for next ______ years
I will like to loan $________ interest-free to Jain Center for five years
I have already pledged my commitment. Amount $________
I can not make commitment at this time, please contact me in ____ months
Please sign below to acknowledge that you received this correspondence.
Signature of the parent ________________________ Date ______________
Without Jainism in my life, I would be a lost soul. To me being a Jain is a privilege. Sonal Sheth
A classroom is where everyone learns, the student and the teacher. Kaanan Shah
We are very happy that our children have a place to learn about Jainism and Indian culture and have a place to meet children
with similar background and philosophy. Archana and Kamal Jain