2018-2019 Chicago City Bala Vihar Registration Form
Fees: $ 450/ child $ 900 max per family (for 2 or more children)
(Fees don't cover books & supplies. Please buy the books from the book store and pay directly at the time of purchase.)
Address of location: Bennett Day School - 955 W Grand Avenue, Chicago, IL 60642
Session Start Date: Sunday September 16, 2018 - 9:30 - 11:30 AM
For Existing Patron's please Click Here
       



Parent Information:
* Last Name (Please enter both father & mother's last names) (e.g. Jain & Iyer, Smith & Sharma, etc.)
* First Name (Please enter both Father & Mother's first names) (e.g. Ram & Sita, Krishna & Radha, etc.)
* Address
* City * State * zip
Emergency Contact Emergency Number
* Home Phone
Father's mobile Mother mobile
* Father email (ONE EMAIL ONLY) * Mother email (ONE EMAIL ONLY)

Please choose a payment method:

Paying by Check Paying by Cash Paying by CC
(For paying by CC option, you will be taken to the credit card payment page via paypal.)

Student Information:

Please enter the information of all the Children below
(Strictly Enforced!) - All children must be 4 year old by September 1, 2018
*Firstname *Lastname
*Date of Birth (MM/DD/YYYY) * Grade (As of Fall 2018)
Gender: Male Female
Comments

Student Information Child 2:

*Firstname *Lastname
*Date of Birth (MM/DD/YYYY) * Grade (As of Fall 2018)
Gender: Male Female
Comments

Student Information Child 3:

=
*Firstname *Lastname
* Date of Birth (MM/DD/YYYY) * Grade (As of Fall 2018)
Gender: Male Female
Comments