Regn. No. ....

Please paste the latest photograph of the child here.

Date of Submission

RAGHUBIR SINGH JUNIOR MODERN SCHOOL HUMAYUN ROAD, NEW DELHI-110003

APPLICATION FOR REGISTRATION TO PRE-SCHOOL CLASS

ACADEMIC SESSION 2012-2013 Please read the instructions overleaf. Certificate from the parent (overleaf) must be signed for acceptance of this form.
(PLEASE FILL IN BLOCK LETTERS) 1. Please indicate the category to which you are applying with a Alumni 2. 3. Name of the Child Date of Birth: DD Sibling

in the relevant box : General Boy / Girl __________ Age as on 31.03.12 ____________

_______________________________________ MM YYYY

Date of Birth in words _____________________________________________________________ 4. Details of Childs Parents: Name Residential Address Father Mother _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________

__________________________ _______ _________________________________ _________________________________ _________________________________ Tele. No. (Residence) _________________________________ (Mobile) ________________________________ E-mail ID: _______________________________________ 5. 6. Are you a single parent? Yes No

Does the child have some special needs?

No
Yes No

If yes, give details __________________________________________________________________________ 7.

No. of other children ____________. If attending school, please indicate:

Name of the child ______________________ ______________________ Name of school attending _____________________ _____________________ Class/Sec. _________ _________

8.

Photocopy of any one of the following documents is to be enclosed: Voter ID / Passport / MTNL Landline Bill / Electricity Bill. Details of Alumni: No. of 1st Generation Other Generations ________ ________ P.T.O.

9.

RAGHUBIR SINGH JUNIOR MODERN SCHOOL

HUMAYUN ROAD, NEW DELHI-110003 GENERAL INSTRUCTIONS 1. 2. 3. 4. 5. Kindly fill in the form in CAPITAL LETTERS only. Please use only a blue / black ball pen to fill the form. Do not enter the registration number yourself. Use appropriate tick mark

in the relevant box given in sections 1, 5 and 6.

Please attach the photocopies of the following documents on the day of submission of form. Incomplete form will not be accepted. a. b. c. d. e. Proof of residential address. In case of sibling applicant, duly signed certificate from the school office. In case of parent / grandparent being alumni, duly signed certificate from the school office. In case of applicant with special need, authenticated document / certificate. Date of Birth Certificate of the child.

6.

Kindly note that the school DOES NOT provide transport facility to Pre-School class.

CERTIFICATE FROM THE PARENT I / We accept the process of admission undertaken by the school and I / we will abide by the decision taken by the school authorities. I / We also understand that the application / registration / wait listing does not guarantee admission to my/our ward. I / We hereby certify that I / we have not applied at Modern School, Vasant Vihar. I / We hereby certify that the above information provided by me / us is correct. I / We understand that if the information is found to be incorrect or false now or later, my / our ward will be automatically debarred from the admission / continuance without any correspondence in this regard.

(Signature of Mother) Name of Mother _______________________________

(Signature of Father) Name of Father __________________________