ST.

JOSEPH’S HIGH SCHOOL, BHUBANESWAR

APPLICATION FORM FOR NURSERY / PRE – NURSERY

INFORMATION
INFORMATION ABOUT THE CHILD:

1.a) FULL NAME ( in Capital letters ) ……………………………………………………….

b) GENDER……………………….
GENDER……………………….c)
……………………….c) Date of Birth…………………………
Birth…………………………

(in
(in words) ………………………………

d) Mother Tongue
ongue ……………………..e)
…………………..e) Rel
Religi
igion……
on……………………………………

f)Caste-
Caste- SC /ST /OBC /Gen…
/Gen…………………..g)
.g)Nat
g)Nati
National
onality
ity…………………….

II.) Give further& useful information, if any

any, for better understandi
understanding of the chi
child.

111. INFORMA
NFORMATION ABOUT THE PARENTS /GUARDIAN :

I. a) Father's/Guardian's full Name………

Name………………………………………………….

b) Occupation & Designation

Designation………………………………………………………

c) Office Address with Phone No…………………………………………………….

………………………………………….. Mail id; ……………………………………………………………...

d) Monthly Income ………………………………………………………………

2. a) Mother's Full Name ……………………………………………………………

b) Occupati
Occupation & Desi
Designation
gnation …………………………………………………………

c) Office Address with Phone No……………………………………………………

d) Monthly Income
ncome ……………………………………………………………

IV 1. RESI
RESIDENTI
DENTIAL ADDRESS WITH PHONE NO./ CELL…………………………
CELL…………………………

……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………….

PTO
2. INCASE OF EMERGENCY,
EMERGENCY,PLEASE CONTACT:(address
CONTACT:(address with Phone No)

……………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………..

V. Approximate distance from your home to School..

chool........
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VI. SPECIFIC reasons for seeking admission to this School.

VII
VII . Health Condition of the Child ........
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NAME OF THE SCHOO L LAST

LAST ATTENDED
TTENDED ......
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Class to which admission is sought.......

sought......................
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...'. ........
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NOTE:
NOTE:
• If 2nd Language is Hindi
3rd Language will be Odia ( Tick )

• 2nd Language-
Language- Odia
3rdLanguage will be Hindi
( Tick )

3rd Language Drops in STD-

STD-VII. 2nd Language Continues till STD-
STD-X.
Change of Language that you have Chosen will not be Changed later.

Date: Signature
Signature

Please Note:

1. The date of birth once entered in the school register ,can not be changed.

2. Submitting
Submitting the compl
completed
eted Applicati
Applicati on form to the school does not mean automatic admission.

Date: Signature of the Parents /Guardian