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Registration No.

Admission Year:

Play group -- Nursery -- Kindergarten -- Activity center

Application for Admission to : Playgroup / Nursery / Junior KG / Senior KG


1, This form is an integral part of the admission process. Please provide correct
information.
2. Completed forms must be submitted to the SHAISHYA OFFICE within a fortnight from
date of issue.
3. In all matters pertaining to admissions, the decision of the SKC Management will be
final.
4. The information that you provide to Shaishya , will be used to facilitate admission
procedures and maintain an academic history. In addition, this information will be used for
administering, evaluating and marketing school program, and for statistical purposes.
Your personal information is protected and treated with respect.

Photo of the child

About the Child: (in BLOCK LETTERS)


Name of the Child:
First Name

Date of Birth:

Middle Name

Last Name

Gender: Boy / Girl

Place of Birth:

Any allergic illness that the child suffers from:


No. of people at home:

Kind of family: Nuclear

Joint

Single

Religion:

Name of the school / pre-school child is attending (if applicable):


Residential Address:

Telephone (1):
Telephone (2):
Mobile:
E-mail:

Approximate distance from the school:

Sibling Details: Name


(if any)

Age

Gender

School

(if applicable)

Details about the Parents (BLOCK LETTERS):

a). Fathers Profile


Name of the Father:
First Name

Middle Name

Qualification:

Date of Birth:

Name & Address of the school attended:

Last Name

Language/s known:
Name & Address of the college attended:

Profession / Work / Business / Occupation:


Name of the Organization : _______________________________________________
Office Address :
Telephone (1):
Telephone (2):
Mobile:
E-mail:

a). Mothers Profile


Name of the Mother:
First Name

Date of Birth:

Middle Name

Qualification:

Name & Address of the school attended:

Last Name

Language/s known:
Name & Address of the college attended:

Profession / Work / Business / Occupation:


Name of the Organization:________________________________________________
Office Address :
Telephone (1):
(if any)

Telephone (2):
Mobile:
E-mail:

Incase of emergency:
Name of the person
to be contacted

Relationship with the Child

Numbers to be contacted

Childs Doctor:
Name of the pediatrician:
Clinic Address:

Telephone (1):
Telephone (2):
Mobile:

General Information:
1. How much time father spends with the child at home? What all do you do together?

2. How much time mother spends with the child at home? What all do you do together?

3. If both parents are working who looks after the child?

4.What language(s) is spoken at home?

5.Does your child have any special needs we should be aware of?
If yes, please describe in detail:

Yes

No

6.Does your child have adequate company of his/her age at home or in the neighbourhood?
Yes

No

Age criteria:
Playgroup: 1-2.5 years
Nursery:
2.5 -3.5 years
Jr Kg:
3.5 years as on 31.3.2011
Sr KG:
4.5 years as on 31.3.2011
UNDERTAKING BY THE PARENT / GUARDIAN
I hereby agree that all the information pertaining to admission is true, correct and complete. I understand,
that if any of the information provided is found to be false, the admission will be cancelled.
In case my child / ward is selected for admission, I undertake the following:1. Accept management's decision regarding his/her stay or withdrawal keeping in view betterment of
the child/campus.
2. Term Fee will be deposited within the stipulated time.
3. School takes utmost care of each child, but parents will not hold staff and management responsible
for any mishap or accident on the campus or while outdoor visits and picnic.
4. HOD is hereby authorized to sign the documents in case of any Medical attention.
5. All the information provided is true and complete. If any of the information provided is found to be
false, the application is subject to rejection.

Signature of Father

Mother

Guardian

Date:
Please submit the following with the admission form
a. A copy of birth certificate.
b. Recent passport size 8 photographs of the child.

For official purpose only:


Remarks of Admissions committee:

Sign

Sign

Sign

Date

Date

Date

Mode of Payment: Cash


Entered by:

Cheque
Date:

Verified by:

Date: