College Admissions Form

PATHSHALA

An initiative by Ballarat Nepali Samaj
Student Name

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Gender
E-mail Address
example@example.com
Phone
Format: (000) 000-0000.
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (Leave Blank If Same As Residential Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Information
Please list any allergies, medical contions or special requirements

Guardian Name

First NameMiddle InitialLast Name
E-mail Address
example@example.com
Phone
Format: (000) 000-0000.
Emergency Contact Name
Full Name
Emergency Contact Phone
Format: (000) 000-0000.

Special Needs Requirements

To help us provide the best possible learning experience and ensure your child's safety and comfort, please let us know if your child has any special needs, medical conditions, allergies, or requires any specific accommodations. This information is voluntary and will be kept confidential.
Please describe any needs or accommodations
Or would you like us to contact you to discuss this privately?

Payment Information

Please make your payment via bank transfer using the following details:
Bank Transfer Details:

Account Name: Ballarat Nepali Samaj Inc.
BSB: 633000
Account Number: 208 114 934

Payment Amount: $50.00 (per child per term)
Payment Reference: Please use the student's full name as the reference.
Payment Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please upload the screenshot of your payment

Cancelof

PATHSHALA: Terms and Conditions
1. Book Policy: The first copy of the course book is provided free of charge. Requests for additional copies will incur a fee to cover printing, binding, and administration costs.
2. Payment Policy: Your child's registration is confirmed only upon receipt of the full term payment. Partial payments will not secure enrollment.
3. Attendance: Regular attendance is essential for your child's optimal learning and to foster a strong community environment within the program.
4. Student Conduct: All students are expected to maintain respectful and appropriate behavior during all classes and activities.
5. Refund Policy: For any inquiries regarding refunds, please contact the BNS PATHSHALA administration directly.
Disclaimer

PATHSHALA is committed to each child’s learning journey. However, we do not guarantee specific academic or developmental progress, as outcomes may vary based on individual differences and other factors beyond our control.
Parental Acknowledgment & Consent
By submitting the registration form, I confirm that I have read, understood, and agree to the policies outlined by BNS PATHSHALA, including those related to attendance, payments, student conduct, and the developmental disclaimer.

I acknowledge that:
1. I take full responsibility for my child’s participation in the program.
2. I understand that PATHSHALA does not guarantee specific developmental or academic outcomes.
3. I agree to support the program’s values, policies, and expectations.
4. I grant permission for my child’s photo, video, or classwork to be shared for educational or promotional purposes by PATHSHALA, unless I notify the administration in writing.
5. I understand that failure to comply with program policies may result in the termination of my child’s enrollment.
Signature

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Should be Empty:

PATHSHALA

Special Needs Requirements

Payment Information

Disclaimer