SSV BALGOKUL

Run by Sri Siva Vishnu Temple, MD and VHPA Inc.

Registration Form – 2012 - 2013

For Inquiries Contact SSV Temple at 301-552-3355, Email:

One form per family – applicable for returning and new families

Child 1: ______Date of birth: ______M( ) F ( ) Class______

Child 2: ______Date of birth: ______M( ) F ( ) Class______

Child 3: ______Date of birth: ______M( ) F ( ) Class______

Father’s Name ______Cell # (______) ______

Mother’s Name ______Cell # (______) ______

Home address: ______

City: ______State: ______Zip: ______Home # (______) ______

Primary email ID: ______

Other email ID: ______@______

FEE Information (subject to revision)-

(Please provide separate checks for SSVT, BalGokul and pay CASH for activity fee)

Registration Fees (Includes curriculum materials): (Check payable to “BalGokul”)

1st Child $75, 2nd Child $50, Each Additional Child - $40 : $ ______

Sri Siva Vishnu Temple (per family) (Check payable to “SSVT”) : $ 101.00

Activity fees (per family) (Payable in Cash $50 per family: $ ______

Volunteer Hours (per family) 8 hours during the year OR $30 (in cash) : $ ______

TOTAL AMOUNT DUE : $

* Check for $ ______drawn in favor of “BalGokul” -- Check # ______

* Check for $101 drawn in favor of “SSVT” -- Check # ______

* Cash enclosed for $____ for activity fees, $___volunteer hrs -- Receipt # ______

Terms & Conditions of Registration for 2011-12:

1. Program duration would be 9 months, following Fairfax County academic year September through June.

2. Classes would be held once a week on Sunday at Durga Temple, Virginia.

3. Timing of the classes: 4 pm – 6 pm, followed by temple Aarti and Bhandar.

4. Age group guidelines:

a. Pre-prarambika (less than 5 years, attending pre-school)

b. Prarambika (5-7 years, attending Kindergarten through Grade-2)

c. Madhyama (8-12 years, attending Grade-3 through Grade-7)

d. Uttama (13 years and above, attending Grade-8 and above)

5. Fee structure

a. SSV Temple - $151 per family for full year

b. BalGokul - $75 (1st child), $50 (2nd child), $40 (3rd child onwards)

c. Yearly lump sum is to support SSVTBalGokul administrative expenses - $ $50 per familiy. This amount is to meet operational expenses.

6. Parents must be present at the temple at all times when their children are in the temple premises.

7. BalGokul is run by volunteers. For efficient running of the program on Hindu dharma and heritage, parents are expected to volunteer and share responsibilities in various activities of BalGokul and Sri Siva Vishnu Mandir. Members of the SSVBalGokul Core Team will contact parents who have signed for volunteer hours and assign them responsibilities from time to time to assist in the efficient running of the program.

8. Parents are expected to follow all rules and regulations applicable to the program. For a copy of rules and regulations, please contact any member of the Core Team.

THE FOLLOWING TO BE SIGNED BY PARENTS/GUARDIAN

I would like to become a member of VHPA (optional, at no additional costs), and share my contact information with VHPA: Yes No

Name:______Signature:______Date:______

I would like to become a member of SSVT(optional, at no additional costs), and share my contact

information with SSV Temple: Yes No

Name:______Signature:______Date:______

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