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HindiUSA Edison Chapter (Non Profit Volunteer Organization)

Mailing Address: HindiUSA, 8 Roxy Ave, Edison, NJ 08820
http://www.hindiusa.org E-mail: Edison@hindiusa.org
Contact: Raj Mittal (732-382-8635) / Manak Kabra (718-414-5429) / Gopal Chaturvedi (908-720-7596)

Hindi Classes held every Friday, 7pm - 8:15 pm from Sept. thru June at
James Madison Intermediate School, 838 New Dover Road, Edison NJ 08820

Hindi classes in 9 levels (PKG-8), Ages 5-16. Also 2 levels of Adult classes (Beginner & Advance)

Total fee of $225 for the whole year (includes textbooks). Sibling fee is $175 (if registered before Aug.
15, 2010)

Classes start September, 2010 and will run thru June 2011

Students will learn reading, writing and speaking in Hindi through attractive books, software, and
curriculum

Students will have a chance to participate in Kavita Path Pratiyogita & Hindi Mahotsav (Largest Annual
Hindi Program in North America)

Students will receive certificates for passing Hindi examination

Students are taught by experienced teachers
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APP!! CCllaassss ssiizzeess aarree lliim
miitteedd!!!! To register, mail the below form to the address
given above with a check of $225 ($250 after August 15, 2010) payable to HindiUSA.
Registration form can be downloaded from www.hindiusa.org

Student’s Name:_________________________________________________________________
Student’s name in Hindi (optional): _________________________________________________
Date of Birth: ______________ Gender: M / F______ Current Hindi class level: _________
Is this New Admission? Yes / No / Transfer (please circle one)
If Transfer, please provide current HindiUSA school name: ____________________________
Parent’s/Guardian’s Name: __________________________ Mother Tongue: _______________
Address: ________________________________________________________________________
Phone (Home):__________________________ Phone (Mobile): _________________________
Parent’s/Guardian’s E-mail (Required): ____________________________________________
CONSENT: I, the undersigned, state that I am the parent and/or legal guardian of the student named above. If my child is found to be
disruptive in the Hindi class by the classroom teacher(s), I accept his/her dismissal from the classroom for the rest of the school year.
Classroom teacher(s) decision is final and I agree to abide by that decision. I also accept liability for any material damage caused by my
child’s behavior in school. I accept that there will be no fee refunds, if my child voluntarily drops out of classes during the school year for any
reason, or is dismissed.

I/WE, on behalf of ourselves and ____________________________________(child/children's name) do hereby agree to hold HindiUSA a
non-profit organization, and its representatives, staff and members, volunteers, paid or unpaid, harmless from any responsibility or liability,
any and all bodily injury and illness claims, demands, damages, costs, expense actions and cause of action arising from any act or
occurrence while attending HindiUSA classes or as a result of participation in the programs and activities conducted under the auspices of
HindiUSA. Further, I understand that while associated with HindiUSA and while participating in their programs, my child would be
photographed, taped, filmed, which may be displayed via electronic media, but not limited to media such as YouTube, to which I consent. I
hereby waive all rights to privacy in photographs and videos, and to compensation related to the use of photographs and or videos.

I/We agree to indemnify HindiUSA and its representatives, staff and members for any costs or liabilities which they may incur as a result of
our or our child's participation in any of its programs. Furthermore, I/We waive any liabilities that HindiUSA and its members may have to me
and my said child/children as a result of any injury, illness, or property damage while participating in their programs. I/We fully understand
and assume full responsibility for our and our said child/children's actions while entering into this arrangement with HindiUSA.

Signature (Parent/Guardian): _________________________ Date: ________________