o IscHOoL Bangalore ‘The Learning Celebration! photograph Note: Please fill up all the feds of informations. lease fil informations in CAPITAL LETTERS ony ADMISSION FORM Date of Admission: A dy J (OD/MMIYYYY) iPlaygroup CiNursery LKG-1 OKG-2 Admission sought Day care Preferre Particulars of the cl Name: Surname: Name affectionately called at home: Sex: OMale [Female Religion: Date of Bit 1 J (oDjMmyrvry) Age: Years: Months: Days: _! Residential Address: House No. Name of Apratment/Building/House Street Name Land Mark Town/ City Pin Code Language(s) spoken at home: [Malayalam [english Cothers.Particulars of Parents 1) Father ° Name: ¢ Educational Qualification: Ls oa © Occupation: © Name of the Organisatior © Tel. No: [STD Code] dese © [STD Code]_[Off.] ____ [Mob] © Email address: 11) Mother © Occupation: © Name of the Organisatio1 © Tel. No: [STD Code] [Res] © [STDieode] [or] Mob © Email address: Oyes ONo If yes, please specify: © Is your child toilet - trained? les No é © How many siblings does the child have? \ Brothers (mention age) 1. 2: 3. Z Sisters (mention age) 1. 2 a:Medical Record * Blood group: 1) Immunisation History: Vaccination Age Yes(v)_ | No(v) a) BCG os (0-2 weeks) b) DPT (I, 11, 11) (6 = 24 weeks) ) Oral Polio Vaccine (OPV) (6 does) d) Measles @-9 months) 4 ke e) MMR (15 - 18 months) fT (4-6 years) |__9) HBV - Hepatitis (1, II, IL) (up to 24 weeks) |__h) HiB (Meningitis - 3 doses) Under 1 year i) Chicken Pox After 1 year of age 3) Typhoid After 2 year of age k) Hepatitis A (2 doses) After 1 year of age av Note: * Vaccines (a) to (g) are compulsory, ‘© (fh) to (k) are optional, but recommended once a year. II) History of past illness: © Specific aliments suffered in the past: © Surgery undergone (if any): © Allergy (if any): © Does your child suffer from any phobias? Ces LINo If yes, please specify: _ * Isthe child presently on any regular medication? [] Yes C1 No If yes, please specify: = ne © Any special instructions:Declaration of Parent I declaire that the information given is correct and complete and I have not withheld any information. agree to entrust my child under the care of the staff at 1st School. I shall not hold Ist School responsible for any unavoidable mishap or accident. Thave read through the 1st School policies and am in agreement with the said Policies. Signature: Date: Registration Fees Tuition Fees Stationary Fees Day care Fees Fee Details (To be filled in by office staff) Rs, Half yearly = Rs. yearly = Rs. Rs. Rs. SCHOOL Bangalore ‘The Learning Celebration! o Guruvayoor Tel: 0487 310 2299 Mob: 93 87 87 22.99 Emai