REGISTRATION CUM PROVISIONAL ADMISSION FORM

BHAGATJI MEMORIAL MODEL (SECONDARY) SCHOOL

All fields marked with * are required.

Registration for Class *:

Name of the Student (in BLOCK letters) *:

Date of Birth (in numbers) *: (date/month/year)

Date of Birth (in words) *:

Sex *:

Category *:

Class for which admission is sought *:

Mother's Name (in BLOCK letters) *:

Office Address (if applicable):

Residential Address *:

Telephone (Resi) *:

Telephone (Office):

Telephone (Mobile) *:

Father's Name (in BLOCK letters) *:

Office Address (if applicable):

Residential Address *:

Telephone (Resi) *:

Telephone (Office):

Telephone (Mobile) *:

Is the School Transport required? *:

Medical Information: (Do your ward needs special care?):

If yes, please provide details (strictly for school use):

Information on parameters adopted by the school:

Core Categories:

Economically Weaker Section :

Socially Disadvantaged Group :

Is the admission sought under seats reserved for economically weaker section of society:

If yes, Total annual income of parents :

Siblings (Real brother/sister only) :

Sibling Name :

Class & Section :

School Alumni:

Mother:

Father:

If your ward is physically challenged?:

Please register my son/daughter/ward named above in your school, I shall produce the requisite documents at the time of admission.