Balodyan's Adult Hindi / Marathi Class Enrollment Form 
Balodyan's Highly Acclaimed Standards-based Hindi-Marathi Immersion Course (BHASHIC)
Please fill the information below and click "submit" at the end to enroll for this program. After you submit the form, please send an email to vyayami@gmail.com to confirm your registration. Please send the appropriate payment via Zelle or Venmo to vidya@vyayam.com within 3 business days after your enrollment. Your enrollment isn't complete, until you submit your payment as mentioned above.
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Email *
Student Information
First Name *
Last Name *
Email *
Best phone number during day hours *
Best phone number during evening hours *
Street address *
Town *
State *
Zip code *
Gender *
Date of Birth *
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Objective *
What is your objective in enrolling for Balodyan's Hindi / Marathi Classes ?
Physician and Emergency Contact Information
Student's Primary Physician’s Name *
Student's Primary Physician’s Phone Number *
Emergency Contact Person *
Please enter their full name below.
Emergency Contact Person. *
Please enter their phone number below.
Health Limitations *
Please list any allergies, physical conditions/  health problems that may limit your participation in Balodyan's Hindi / Marathi learning activities:
Student's Current Hindi / Marathi Proficiency *
Please choose all that apply
Required
Which day and time are you enrolling for ? *
What is the primary language student speaks at home ? *
How did you hear about Balodyan's Hindi / Marathi classes ? *
Please check all that apply.
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If your friend referred you to Balodyan, please enter your friend's name below. If you found us online, please mention the search engine / website that referred us, otherwise say N.A. *
Is there anything else you want to mention / ask us ? *
Agreement of Release and Waiver of Liability - Please read and consent
I hereby agree to the following : That I am participating in Hindi / Marathi classes offered by Vidya Nahar through BHASHIC (Balodyan's Highly Acclaimed Standards-based Hindi-Marathi Immersion Course), at in person at Balodyan in Buffalo Grove / onine, during which I will receive information and instruction about speaking, reading and writing Hindi / Marathi through authentic materials, including, but not limited to, text media, cultural objects, songs, movies, books, and technology. I recognize that some of these activities require physical exertion, which may be strenuous and may cause physical injury, and am fully aware of the risks and hazards involved.

I understand that it is my responsibility to consult with a physician regarding any limitations I may have prior my participation in above-mentioned classes at Balodyan. In consideration of being permitted to participate in Balodyan classes, I knowingly and voluntarily and expressly waive any claim I may have against Vidya Nahar and / or Balodyan for injury or damages that I may sustain as a result of participating in Balodyan classes and program.

I, my heirs, and / or legal representatives forever release, waive, discharge and prospectively give up any right to institute any claim, suit or action against Vidya Nahar and / or Balodyan for any injury or death caused by my participation in the program. My prospective waiver and release shall apply to all claims and demands or causes of action including those that may arise out of the active / passive negligence of those hereby released.

I have read the above release and waiver of liability form and fully understand its contents. I voluntarily agree to the terms and conditions mentioned above. I have received and read Balodyan’s Payment Policy and agree to abide by it.

Affirmation and Singature
By entering my name and date below, I agree that all information mentioned above is true to my knowledge.

After submitting this form, hit back arrow on your browser to reach Balodyan. Please note the applicable registration fee per registrant and  kindly mail your check payable and addressed to Balodyan, 1165, Alden Lane, Buffalo Grove, 60089 within 3 business days after submitting your form.  You may also make your payment via Chase Quick Pay / Venmo / Zelle to vidya@vyayam.com .
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