Student Registration Form for Summer 2011 Hindi Program
Student Name: ___________________________________________
Name in Hindi: (Optional) _______________________ Meaning _______________
Address: _________________________________________________________
Emergency Phone #: ( ) -
Date of Birth: ____________________
Interests and Hobbies: ______________________________________________
email address:
How frequently do you read your email At least Once a week/At least once a day
Dates enrolling for: __________________ Location ( Palo Alto Only )
(Office use only) Date Received ________ Enrolled/Wait Listed____________
Parent’s Information
Name: _____________________________________________
email: _____________________________________________
(New Students only)
Who can we thank for introducing you to our program? ________________
Comments/Expectations/Special Requests:
__________________________________________________________________
__________________________________________________________________
Send Registration Information and check to
MBK Language Center,
Nondiscriminatory Policy: MBK Language Center admits students of any race, color, national or ethnic origin to all the rights and privileges, programs and activities generally accorded or made available to students at our schools. The organization does not discriminate on the basis of race, color, sexual preference, national or ethnic origin in administration of our educational policies, scholarships and other school-administered language programs.