DURGA BALGOKUL (DBG)

Registration Form – 2018 - 2019

For Inquiries contact the DBG coordinator via email: dbgcoordinator@gmail.com
One form per family – applicable for returning and new families
(Children ages 3 – 18)

Classes

Pre-P (3 – under 5yrs)
P1 (5 – 6 yrs)
P2 (7 – 8 yrs)
M1 (9– 11 yrs)
Youth (over 12yrs)

(P = Prarambhika, M = Madhyama)

Fees and Charges

Durga Temple - No charge
Supplies (non-refundable fees)
- Books - ~ $15 each child
- Activity fee - $50.00 first child
  - $40.00 – second child (sibling)
  - $30.00 – third child (sibling)

Child 1: *	Date of Birth: *	MF	Rising Class: *
Child 2:
Child 3
Father's Name: *		Cell#: *	(10 Digits only. No Spaces/Dashes allowed)
Mother's Name: *		Cell#: *	(10 Digits only. No Spaces/Dashes allowed)
Home Address: *
City: *	State: *		Home Phone#: *	(10 Digits only. No Spaces/Dashes allowed)
Primary Email ID: *
Other Email ID:
Are you interested in becoming a BalGokul Teacher? *

Do you have child health insurance? *

Yes, I agree , I hold Durga Temple (Fairfax Station, VA) and Fairfax county in the State of Virginia, harmless for any and all liabilities arising out of me and/or/my children's participation in the BalGokul activity. In the event of medical emergency, any medical help available to the organization may be used. I will be responsible for all medical and related expenses."

I hearby, release Durga Temple and Fairfax County from any and all claims. I further agree to abide by the terms and conditions of the program, rules and regulations as decided by Durga Temple from time to time.

* Terms & Conditions of Registration :

Program duration would be 9 months (Sept. 2018 thru June 2019)
Classes would be held once a week on Sunday at Durga Temple, Virginia.
Timing of the classes: 10:00 am – 11:30 am
BalGokul is run by volunteers. For efficient running of the program on Sanatana (Hindu) dharma and heritage, parents are expected to volunteer and share responsibilities in various activities of BalGokul and Durga Temple.
Parents of children ages 3 – 5 yrs. old (Pre-P) class must sit with the child in the class.
Parents or delegated Guardians ARE REQUIRED to be on-premise at Durga Temple at all times when children are attending the DBG program. Children CANNOT be dropped off for the DBG program unsupervised.
Parents are expected to follow all the rules and regulations applicable to the program, including Durga Temple policies. For further information, please contact DBG PoC at dbgcoordinator@gmail.com

Thank you so much for spending time on Balgokul web page. If you wish to register your child, please fill out the form above and submit online.