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Gayatri Chetna Center

240 Centennial Avenue,
Piscataway, NJ - 08854
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Youth Camp Registration

Home›Youth Camp Registration

Winter Youth Camp

Gayatri Pariwar of NorthEast USA

Gayatri Chetna Center
240 Centennial Avenue,Piscataway, NJ-08854

December 19th, 2009

* Mandatory fields

* First Name :
* Last Name :
* Age Group :
* Gender :
* Parent's Name :
* Street Address :
Address Line 2 :
* City :
* State :
* Zip Code :
* Phone (Home) :
Mobile :
* Email :
* T-Shirt (Size) :

Emergency Contact Information

* First Name :
* Last Name :
* Home Phone :
Mobile :

Doctor / Medical Information

Doctor Name :
Doctor Office Phone :
Specify any Allergy/Medical condition and/or special medication that the child may be taking / or Any food restrictions or special instructions that we may need to know :

Others

Cultural Program Participation (Are you participating in Cultural Activities?) :

Room assignment request (We do our best to accommodate your request but no guaranty.) :

Payment Related Information: Lodging & Boarding: $150 Per Youth / $180 Per Adult

Check payable to 'Gayatri Pariwar NE'

Check mailing address
Aruna Patel
345 Orchard Ave.
Langhorne, PA 19047

NOTE : Please include your Camp Registration Number on Check memo.

Terms & Cancellation policy:

Registration is limited and will be accepted and confirmed on a first come, first serve basis with a payment. Registration fee is “Non Refundable”. A waiting list will be established for the registration occurred after the camp is full. All participants must attend all the events. Participants are not allowed to leave the premises without parent’s consent.

Allergy: There is a growing concern about allergies. In an attempt to keep our camp records updated, we request that you list your child’s allergies, if any.

Disclaimer: Gayatri Pariwar Northeast is not liable / responsible for any loss, personal belonging, and/or any injury.