APPLY-NOW – Mondrian School

TO BE FILLED UP BY SCHOOL

FORM NO:

ISSUING AUTHORITY

DATE OF ISSUE:

TO BE FILLED UP BY PARENTS ↓

PLEASE UPLOAD A PHOTOGRAPH OF YOUR CHILD HERE

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CHILD'S FULL NAME

First Name *

Middle Name *

Last Name *

NICK NAME

DATE OF BIRTH *

DOB IN WORDS: *

AGE AS ON 31ST MARCH *

GENDER *MALEFEMALE

NATIONALITY *

BLOOD GROUP

PRESENT SCHOOL:(IF ANY)

PERMANENT RESIDENTIAL ADDRESS: *

PRESENT RESIDENTIAL ADDRESS: *

Email:

SCHOOL TRANSPORT REQUIRED: *YESNO

MOTHER'S NAME

EDUCATIONAL QUALIFICATIONS:

OCCUPATION

FATHER'S NAME

EDUCATIONAL QUALIFICATIONS:

OCCUPATION

DO YOU LIVE IN A NUCLEAR OR A JOINT FAMILY? (PLEASE SPECIFY):

IS THE CHILD ALLERGIC TO ANY MEDICINE OR FOOD?(PLEASE SPECIFY):

PLEASE INDICATE THE PERSON TO BE CONTACTED IN CASE OF EMERGENCY

Name *

RELATIONSHIP WITH THE CHILD: *

CONTACT NUMBERS: *

SIBLINGS, IF ANY

Name

DOB

GENDERMALEFEMALE

CLASS

SCHOOL

IS THE ADMISSION SOUGHT UNDER THE SEATS FOR ECONOMICALLY WEAKER SECTION?YESNO

NAME AND ADDRESS OF 2 REFERENCES WITH CONTACT NUMBERS:

UNDERSTANDING:I UNDERSTAND AND AGREE THAT THE REGISTRATION OF MY CHILD DOES NOT GUARANTEE ADMISSION TO THE SCHOOL AND THAT THE REGISTRATION FEE IS NEITHER TRANSFERABLE NOR REFUNDABLE.

NAME OF THE PARENT :

DATE:

SIGNATURE:

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THIS APPLICATION MUST BE ACCOMPANIED BY A CHEQUE IN FAVOUR OF 'MONDRIAN HOUSE PRIMARY SCHOOL' FOR A SUM AS PER SCHEDULE AND A SELF ATTESTED COPY OF THE BIRTH CERTIFICATE OF THE CHILD , AS ISSUED BY THE VILLAGE OR MUNCIPAL AUTHORITIES , OR BY THE HEAD OF A REGISTERED NURSING HOME, OR BY MEDICAL PRACTITIONER WHO DELIVERED THE CHILD (WITH HIS/HER MEDICAL COUNCIL REGISTRATION NUMBER). NO AFFIDAVITS OR SCHOOL CERTIFICATES ARE ACCEPTABLE.

PLEASE UPLOAD RECENT PASSPORT SIZE COLOUR PHOTOGRAPH OF THE PARENTS FOR SECURITY REASONS AND TO FACILITATE THE PRINTING OF CHLD'S ID CARD

PLEASE UPLOAD IMAGE OF CHILD'S MOTHER

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PLEASE UPLOAD IMAGE OF CHILD'S FATHER

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Date

Two Schools One Community

Two Schools One Community

PLEASE INDICATE THE PERSON TO BE CONTACTED IN CASE OF EMERGENCY

K-3 campus

K-12 Campus

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