Registration Form No. This is not an Admission Form. Somerville International School (Administered by : Hott Carey Baptist Misstox ix Indix) ‘A-07, SECTOR - 132, EXPRESSWAY, NOIDA, DISTT. GAUTAM BUDH NAGAR, ULP.-201 301 Ph: +91-9650506358, +91-a508056799 REGISTRATION FORM Please read carefully the important notes given at the back of this form before filing up PHOTOGRAPH OF CHILD WITH PARENTS, Registration for [Class Session 4. DETAILS OF CHILD Name Date of Birth (In Figures) Date| Montt{ Year (inWords) sex[M]F Age as on 31* March 20. Years| Months [T_] Days Religion : . Note: Attach relevant proof if any of the Category: Sc[~]sT[_]08c[] Original vilagers of NOIDA Reet aoe Present Address of Parent/Legal Guardian Permanent Address of Parent/Legal Guardian Particulars gis Name Class School Name [Class School 2. DETAILS OF FATHER Name Religion Educational / Professional Qualification Present Job Status including Name and Address of the Organisation/Business ‘Annual Income (Consolidated) Income Tax Payee [Yes | No Phone No. Office Residence E-mail Address Mobile No. 3. DETAILS OF MOTHER Name Religion Educational / Professional Qualification! Present Job Status including Name and Address of the Organisation/Business Annual Income (Consolidated) Income Tax Payee [Yes | No Phone No. Office Residence E-mailAddress Mobile No, FOR OFFICE USE ONLY Provisionally admit SloIDIo to Class .. PRINCIPAL4, — DETAILS OF LEGAL GUARDIAN :: (Document Proof required) Name Religion Educational / Professional Qualification Present Job Status including Name and Address of the Organisation/Business ‘Annual Income (Consolidated) Income Tax Payee [Yes [No Phone No. Office Residence E-mail Address Mobile No. 8. Previous School Attended : Total Marks % of Marks Recognized: Yes [No Class 6. Areas in which you could contribute to enfich school life in terms of time, skill etc. (please tick) Cuttural Medical Media Professional Sports ‘Academic 7. Whether School transport required? Yes [| No CERTIFICATE ' hereby state that the information provided by meis true and that the onus of any false / incorrect information shall rest entirely onme: |ully understand that on accepting the registration of my ward, thie school is not in any way bound to grant admission, as the ‘admission is purely based on availabilty of seats. | also understand that the decision of the Principal regarding admission will be final and binding on me. Date Signature of Parent / Legal Guardian Notr PLEASE NOTE: 1. The school provides transport facilities but offers no guarantee that a seat in the school bus will be offered, when the buses are full to capacity / do not ply in the area of your residence. It will be the responsibility of the parent / guardian to drop / collect the child from the specified bus stop. 2. _ Incomplete form will be rejected without assigning any reason. 3, Please attach ) Photograph of the Child along with the Parents to be pasted on the form. b) Photocopy of the Birth Certificate. ©) Photocopy of Marksheet of the last class attended, Please fil in all the details in capital letters and in a legible handwriting by leaving one block blank between the words, (Once the form is filed and submitted by the parent, no change in names willbe allowed, without special permission. ‘No admission willbe entertained without proper documents Nooan Please ensure that the date of birth of your child is written correctly as per the Birth Certificate, No request for change in date of birth will be entertained in future whatever may be the reason. |in case of physically challenged candidates please attach details as annexure, 9. Visit us at www.somervi international, PRINCIPAL