CLUB REGISTRATION FORM

PHOTO

1. Name…………………………………………………………………………………………………………
2. Contact number …………………………………………………………………………………………
3. Email ID……………………………………………………………………………………………………...
4. Course ……………………………………………………………………….Session ………………….
5. Date of Birth ………………………………………………………………………………………………………….
6. Age ………………………………………………………………………………………………………………………..
7. Gender : Male / Female
8. Blood Group …………………………………………………………………………………………………………..
9. Father’s Name & Occupation ……………………………………… Occupation ……………………..
10. Contact number ……………………………………………………………………………………………………..
11. Address …………………………………………………………………………………………………………………..

Choose one mandatory and one optional from the following list. Mark (  ) in front of the selection.

S.No Name of the Club Coach / Guru Option

()
1. FIFA FEVER Mr. Nirmal Singh – international coach from
(FOOTBALL) sports authority of India.

(Young star football academy)

2. MA LONG Mr. Deepak Malik – Coach Indian table
(TABLE TENNIS) tennis team
(Pinnacle academy)
3. UPPERCUT Mr. Angad Chauhan – Professional boxing
(BOXING) coach.
4. CROSS FIRE Mr. Tanuj chaudhary – NIS coach.
(VOLLEY BALL)
5. HOT SHOT Mr. Surjit Singh – National Coach with 15
(BADMINTON) years experience
(Play all Badminton academy)
(Badminton culb court is 4 kms. Far away
from IMS Campus Noida International Level
 court)

6. BRAVE HEART Mr. Rohit Kumar – marathon running coach

(RUNNING & and also coach for track & field
FITNESS)
7. DIVA IN DEFENSE Mr. Dharmendra
(SELF DEFENCE) Blach belt 4th done
8. Shakespeare Club Mentored By Mr. Karan Arora, well known
(Drama & Theatre) theatre personality, worked with many
Bollywood artists
9. Jackson Club Mentored By Mr. Artur Przybylski from
(Dance Club - Poland, professional Western and Kathak
Indian & Western) dance expert
10. Lata Mangeskar Mentored by Ms. Vijya Verma, sangeet
Club alankar in Hindustani Vocal Music, she is
(Music) working with Kala Ashram
11. Hussain Club Mentored by Ms. Anita Kulkarni, well known
(Fine Arts – international painter
Painting &
Sculpting)
12. Wordsworth Club Mentored by Ms. Bipasha Sengupta, she has
(Poetry & Creative written many short stories and poetries,
Writing) translated Tagore’s stories and dance
dramas etc.
13. Harmony Club Mentored by Neelabh Bhattacharya / Vivish
(Rock Band) Pathak, well known tabla player, he is master
of different kind of percussions
14. Makeup Club Sumit Kohli Profession makeup artist

Note: Day & Time of Coaching

Rules & Regulations:-

1. Identity Card should be brought every day and will have to be shown on demand by the
authorized personnel. Unauthorized people / without identity card will not be allowed.
2. IMS Noida – Sports Club & Academy reserves the right to suspend / cancel the
membership of any individual/s without giving any prior notice / reason in the interest
of efficient functioning of arrangements.
3. Indiscipline and any misbehavior will not be tolerated and the membership will be
cancelled there and then.
4. Membership fee of Rs. 12000/- is already included in the 1st year fees. Membership fee
paid once will not be refundable.
5. IMS Noida will not be responsible for loss of any valuable items / cash.
6. IMS Noida will not be responsible for any injury / loss of life during playing period and
such no compensation of claim will be entertained.
 7. Sexual Harassment / Eve teasing will attract legal action and immediate rustication.
8. Small kids or pets are not allowed.
9. For one club minimum 30 students are mandatory
10. Parking of the cars will not be allowed on campus premises.
11. Individuals are not permitted to carry alcohol / drugs / arms & ammunitions or any
objectionable items. In case found on person / premises, strict legal action will be
initiated and leading to immediate rustication.
12. Any other information you think relevant for considering your application
13. Mandatory requirements :-
 Self “Declaration/Undertaking form

I have read the above Rules & Regulations and hereby undertake to abide by them.

Signature of Parents / Guardian Signature of Applicant

Name Name

MEDICAL CERTIFICATE

This is to certify that I have examined Sh. / Km. / Smt. ……………………………………………………….

age ………………… years and found that he / she is not suffering from any chronic / contagious
disease of / any disability which prevents him / her from any physical exercise. As such he / she
is fit for any physical exercise.

Date: Doctor’s Signature

Name & Stamp with Regn. No.

Note: This certificate has to be signed by Regd. M.B.B.S Doctor.