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| Note: Columns
marked with * are compulsory to fill in. |
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Admission Number*
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Admission To Class*
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Academic Year*
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Student's Photograph*
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Father's Photograph*
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Mother's Photograph*
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Student Name*
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Gender*
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Date of
Birth*
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(DD/MM/YYYY) |
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Nationality*
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Preferred Second Language*
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Religion*
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Mother Tongue*
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Present Address*
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Permanent Address*
Same as Present |
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Full Address: |
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| Pin Code |
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Aadhar Number Of Child*
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| Details Of Preschool if applicable
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Present School Name
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Class
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Address:
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| Candidates's Family Information (
All Names should be in full (including surname if any). Initials
and titles are not allowed) |
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Father's Name*
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Academic Qualification*
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School/college*
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Occupation & Designation*
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Office Name & Address*
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Mobile*
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Phone(O)*
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Email*
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Mother's Name*
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Academic Qualification*
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School/college*
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Occupation & Designation*
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Office Name & Address*
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Mobile*
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Phone(O)*
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Email*
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Total Family Income Per Month*
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Brothers/Sisters of student and school details
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| Name Of Sibling* |
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Age* |
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| Class* |
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Name of School/College* |
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| Name Of Sibling* |
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Age* |
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| Class* |
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Name of School/College* |
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| Name Of Sibling* |
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Age* |
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| Class* |
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Name of School/College* |
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Proficiency in Other Languages / Sports / Other activities*
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Other family members staying with the Student (Brothers/Sisters/Grandparents etc.)
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| Name* |
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Relationship* |
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| Age* |
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| Name* |
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Relationship* |
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| Age* |
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| Name * |
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Relationship* |
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| Age* |
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Has the child suffered from any major illness recently? If yes, please mention the illness.*
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Does the child have any chronic ailment/allergy/any other medical history?*
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Contact Persons (In case of emergency)
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Name*
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Relation with the Student*
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Mobile*
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Phone(O)*
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Phone(R)*
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Family Doctor's name*
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Mobile*
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Phone(O)*
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Phone(R)*
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Child's Blood Group*
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What would you like your child to grow up to be ? (Express in brief )
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We (the Parents / Guardian) promise to co-operate with the School in all matters and follow the rules and regulations of the
School. We undertake to pay the School Fees, Transport Fees and other expenses, as it will be notified from time to time by
School Authorities that pertain to the education and well-being of our child / children in IEM Public School.
We will communicate one-to-one with the School Authorities regarding any clarifications or issues that may arise and not
form groups or associations with other parents or third parties that may disrupt the peaceful working environment and
atmosphere of the school in any way.
I/We hereby declare that all the information furnished in this form is correct.
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Father's Signature*
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Mother's Signature*
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Date*
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Date*
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