Pathshala Registration Form 2017

Pathshala Registration Form for the Year September 2022-June 2023
(Note – A child must be in Pre-K and/or 4 years old as of August 2022 to attend the Pathshala. Adult Swathyay members are NOT required to fill out this form – this form is only for students from Pre-K to Grade 12 )

Please Note: It is very important to have accurate information for each student. Please take your time and fill the form accurately.
(Visit jsne.org for Pathshala information)
Last Name of Family*
Father's Name*
Mother's Name*
Address 1*
Address 2
City*
State
Postal / Zip Code*
Phone Number (Home)
1st Preferred Cell Phone*
2nd Optional Cell Phone
1st Preferred Email Address*
example@example.com
2nd Optional Email Address
example@example.com
(Note – The above email addresses will be added to the JSNE yahoo email group for all communications)

You can register upto 3 students using this form
Name of Student (#1)*
Birth Date of Student (#1)*

MonthDayYear
Date
School Grade as of 08/2022*
Current Pathshala Level
Sponsor (optional) Pathshala $301, Class $101

$301$101
---------------------------------------------------------------------------------------------------------------
Name of Student (#2)
Birth Date of Student (#2)*

MonthDayYear
Date
School Grade as of 08/2022*
Current Pathshala Level
Sponsor (optional) Pathshala $301, Class $101

$301$101
---------------------------------------------------------------------------------------------------------------
Name of Student (#3)
Birth Date of Student (#3)*

MonthDayYear
Date
School Grade as of 08/2022*
Current Pathshala Level
Sponsor (optional) Pathshala $301, Class $101

$301$101

Which of the Pathshala activities would you (parent) like to participate/contribute in?

Help TeacherCultural Program ChoreographerFood Co-ordinationClean up activitiesOther
Provide your suggestions regarding our Pathshala meeting times and frequency, curriculum and teaching, and other logistics.
Should be Empty:

Pathshala Registration Form for the Year September 2022-June 2023