Bala Vihar

	First Name
	Last Name
	Date of Birth
	Parents	(ex: Chander & Praveena )
	Address
	City
	State
	Zip
	Email Address
	Contact No 1
	Contact No 2
	Please Choose One	Bala-Vihar Class SAT Preparation Class (Kids 11 years or older)
	Payment	Please make check payable to "HTCC" and hand over the payment to one of the volunteers during the Bala-Vihar/SAT Preparation classes.
	Payment By
	Expectation

	Type the characters you see in the picture .