Name of the Ward *
(in block letters)

Name of Father *

Name of Mother *

Date of Birth *

Date Month Year

Admission in Class *

Qualification of 

Father

Mother

Profession of 

Father

Mother

Permanent Address 

Present Address *

 Your E-Mail ID *

 Phone Number

Mother Tongue of Child

If already studied n Some Other School, Please Mention

Name of the School Last Attended

Class last studied

Subjects offered

Percentage of Marks secured in last term exam

Religion

Whether Child 
belongs to

  SC ST OBC Category If yes, 

mention the caste / tribe

Hobbies, If any

Games Played

Has he / she been awarded for earning a merit ? Mention it, if awarded

Mention Student's 

Weight Height

Does you child suffer any handicap? if Yes, mention it's nature

Would you like to avail the services of school bus

Yes  No

Give distance from you residence to school (in kilometers)

Income of Parents (P.A.)

Nationality of Parents

I hereby certify that the Date of Birth mention here is correct, I also certify that all the information provided herein is correct to the best of my knowledge and breif.

Submitted by *