New Student Registration Information –
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
Class enrolling for: (Level and location) ____________________
(Office use only) Date Received ________ Class Assigned ________________
Parent’s Information (if student is under 18)
Name: _____________________________________________
email: _____________________________________________
Who can we thank for introducing you to our program? (New Students only)
________________________
Discounts if Any:
Comments/Expectations:
__________________________________________________________________
__________________________________________________________________
Send Registration Information and check to
Madhu Bhasha Kendra,
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.