CMH Registration Form (Family Information)

Registration Date *

Month Day Year

Family/Last Name *

Enter the last name for the household

Home Phone *

XXX-XXX-XXXX

Address *

Street Address

Street Address Line 2

City State

Zip Code

Your Information:

Name *

First Name Last Name

Gender *

E-mail *

Cell Phone *

XXX-XXX-XXXX

Work Phone

XXX-XXX-XXXX

Occupation

Married *

Spouse's Information:

Name *

First Name Last Name

Gender *

E-mail *

Cell Phone *

XXX-XXX-XXXX

Work Phone

XXX-XXX-XXXX

Occupation

Returning Family? *

Choose 'Yes' if you were a CMH member earlier.

Are you registering children for Bala Vihar (Note: Registration for grades 8 and 9 in Session 1 is frozen at this time) *

Yes No

Number of Bala Vihar Children Registering *

Registration Fee (non-refundable)

Registration Fee (Family without Bala Vihar Children) $ 25.00

Total $ 0.00

Please review your form before clicking 'Submit'.

Chinmaya Mission Houston (CMH) - Registration