"/,4befr#-"J REGISTRATTON NO.: P h o t o g r a p ho f REGTSTRATTONFEE RS. 3OO/- NON-REFUNDABLE STUDENT Pleaseanswer all question and fill in the information clearly in BLocK LETTERSoNLy GENERAL INFORMATION admission sought for class PERSONAL DATA OF STUDFNT First Name M i d d l eN a m e Surname Date of Birth DD sex:F I] City MM YYYY M l--l Rerision I-l Pin Code Mother ronsue Country Home Tei Mailing Address 'f C'ffu."n, , City l PinCode Country Home Tel EDUCATIONAL SACKGROUND Name of PreviousSchool attended City/State M A R K S / G R A DO E B T A I N E DI N T H E L A S TE X A M I N A T I O N IN CLASS S ,N o . 1. 2. 3. 4. 5. 6. Subject o/o Mat'ks Reasonof leavins PARENTS.GUARDIAN'S INFORMATION Father's/Guardian's Name Photographof Nationality Name of School Examination Passed Name of University Examination Passed Profession L Nature of Business/Service Organisation FATHER/ GUARDIAN Designation OfficeAddress Telephone Mobile M o t h e r ' s/ G u a r d i a n ' sN a m e Age Photographof Nationality Name of School Examination Passed Name of University Examination Passed Profession MOTHER L Organisation Designation OfficeAddress Telephone Mobile No. of brothers/ sister in the family Name of previous school studied Name Class Name Class TRANSPORT Do you require School Bus facility? NOTE: Transport routes are fixed vesl-l NOT AREAS WHERE PAREHTS CONTRIBUTE Ll f tl r n tl tl I tI tl tl T Music/ Dance/ Drama CreativeArt (specify) Printing / Publishing Academics PublicSpeaking / Communication skills Community Service Career Counselling Sp.orts (specify) Media / PR Health Transport Facilities Others DECLARATION / UNDERTAKING registration form is only meant as a request for admissien without any obligation on the part 1.":94*ii9-tf1:tlit o r s c h o o ta u t h o r i t yt o a d m i t m y c h i l d , rh". rules and regulationsof the School.I understandthat these rutesand regulations,inctudins f:f_:.1:.?_b^i9:lI tne structure ot school fees, may be modifiedand amended from time to time, I certify that the informationfurnishedin this form is true to the best of my knowledge. Signatureof ParentI Guardian FOR OFFICE USE Enclosed Residence Proof Birth Certificate TransferCertificate l-l Last Year's Mark Sheet TransferCertificate l-l Admitted Not admitted Class Section With effecl from A d m i s s i o nN o . Remarks S i g n a t u r eo f A d m i s s i o n - i n - c h a r g e CATEGORY; Pick up Route No. Dropping up Route No. Afl BI cI DurgBypass, Katulbod, Bhilai,Dist; Durg P h . :(07s8) 3207A48,7566660478, 756666047 1, 7 566660472 r Website: www.herigateschools.org E - m a i l [email protected] : Rs. 1OO/- Sl. No.: