2014 Summer Day Camp

Registration Form

HINDMOTOR
MAHESWARI
MAHILA
SANGATHAN

To be completed by parent or guardian:

1. All required information must be complete before registration is accepted.
2. Make a copy for your records.
3. Return completed form with your payment to HMMS.
4. Submit one form per child.
5. Children must be the stated age at the start of the session for which they are
registering.
6. All Information filled below must be in CAPITAL LETTER.

DATE: 17th MAY & 18th MAY

TIME: 11 A.M to 6 P.M

NAME: ________________________________________________________
FATHERS NAME: ______________________________________________
AGE (DD/MM/YYYY): __________________________________________
CLASS (Example Standard 1/2/3/4.):______________________________________________
ADDRESS: ____________________________________________________
______________________________________________________________
City:_________________PIN:_____________
CONTACT NUMBER: __________________________________________
**FOR FURTHER INFORMATIONS FEEL FREE TO CONTACT:
Sunita Kabra (+91 9330897235),
Meena Pasari (+91 9477028599)
Madhulika Rathi (+91 9339366661), Madhu Rathi (+91 9331822170)

--------------------------------------------------------------------------------------------------Name: ______________________________
Amount Received: `___________________

Age: _________

Sign:__________________