Vadtal Dham Shree Swaminarayan Hindu Temple

Kids / Youth Religious & Cultural

Classes Enrollment

Name(Required)

First Last

Date of Birth(Required)

Age(Required)

Gender(Required)

Grade Level(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name(Required)

Emergency Phone Number(Required)

Is the student over 13 years old?(Required)

Yes

Health Concerns

Consent(Required)

I agree to the statement below.

I give permission for my son/daughter to participate fully in the program including snacks and games. In
case of an emergency, I understand every effort will be made to contact the parents/guardians of the
child(ren). In the event that I cannot be reached, I hereby give permission for the medical personnel
selected by the school staff to secure proper and necessary treatment for my child(ren) as named on
this form. I also give permission for my child(ren) to be photographed and their pictures to be used in
the school promotional material. I also agree to pay the $50 per year per student enrollment fee to help fund the class activities.

Religious & Cultural Class Fees(Required)

Religious & Cultural Class Fees (Per Year Per Student)

Kids / Youth Religious & Cultural

Classes Enrollment

We accept paypal