Student Registration Form for Summer 2010 Hindi Immersion Camp–
Student Name: ___________________________________________
Name in Hindi: (Optional) _______________________ Meaning _______________
Address: _________________________________________________________
Emergency Phone #: ( ) -
Date of Birth: ____________________
Interests and Hobbies: ______________________________________________
Camper email address:
How frequently do you read your email At least Once a week/At least once a day
Dates enrolling for: __________________ Location ( Fremont or Palo Alto or Los Altos )
(Office use only) Date Received ________ Enrolled/Wait Listed____________
Parent’s Information
Name: _____________________________________________
email: _____________________________________________
(New Students/Campers only)
Who can we thank for introducing you to our program? ________________
Fees: $400/camper/wk
Camp hours are 9:00am to 3:00pm Monday through Friday.
Our Camp will run from Monday July 5th through Friday July 30th.
*Extended Care available from 3:00pm to 6:00 pm. - $60.00/wk/camper
*Hot Lunch option (Vegetarian) - $40.00/wk/Camper
Early Enrollment Specials:
*Free Lunch & Extended Care if enrollment received before March 15th 2010
*Free Extended Care or lunch if enrollment received before April 15th 2010
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.