Youth Camp Registration Form
VIA ZOOM ONLINE
(For Grades: Pre-K to 12th)

(Special Features: Interactions with Swamis & Brahamacharins; Fun Activities & Vedic Chanting)
(Camp Fees: $100/child)

Registration is a three step process: Fill Form, Confirm and Pay

Parent Information (* Required fields - Please enter all required fields):
* First Name * Last Name
* Address
* City * State * zip
Cell Phone * Home Phone
* Father's email Mother's email
* Which Chinmaya Mission Center:
* Who referred you to this camp:
(Previous attendee/Bala Vihar student/Email from Asian Community Network, DesiTalk, Hi-IndiaTimes, etc.)

Payment method, please select appropriately:
Paying by CC Paying by Check
(For paying by CC option, you will be taken to the credit card payment page via paypal.)

PLEASE NOTE THE CHILDREN WILL BE IN THE SAME GRADE IN THE CAMP AS THEY WERE/ARE IN 2020-2021 SCHOOL YEAR. PLEASE MAKE SURE YOU ENTER THE CORRECT GRADE IN THE FORM BELOW AS REQUESTED - GRADE IN 2020-2021

Child 1 (* Required fields - Please enter all required fields):

* First Name * Last Name * Date of Birth (Only in MM/DD/YYYY)
* Grade (In 2020-2021) * Gender:
Interests/Comments

Child 2 (Sibling 1) (* Required fields - Please enter all required fields):

* First Name * Last Name * Date of Birth (Only in MM/DD/YYYY)
* Grade (In 2020-2021) * Gender:
Interests/Comments

Child 3 (Sibling 2) (* Required fields - Please enter all required fields):

* First Name * Last Name * Date of Birth (MM-DD-YYYY)
* Grade (In 2020-2021) * Gender:
Interests/Comments


(NOTE: More then 2 siblings, please contact Suresh Kumar (630-362-0104) to manually add the additional child(ren) after completing the registration!)

If paying by check, please mail the check payable to "Chinmaya Mission Chicago" to the following address:
Chinmaya Mission Chicago
11S080 Kingery Hwy (Rte. 83)
Willowbrook
IL 60527