Write in English and CAPITALS. Use only Blue/Black Ball Point Pen. One character in one Box.

Do not write outside the boxes. SAMPLE How to fill the Form :
Tick inside the appropriate Box only. Male Female
Application for Summer Coaching Programme (Jr.)
Master
Miss.
1. Name
2. Fathers / Mothers Name :
3. Date of Birth in Figures (dd mm yyyy) :
6. Address :
7.Ph. No. :
9.E-mail:_____________________________________________________
Paste passport
size photograph
here
B I J O H A N R M
Age (years) :
4.Name of the School :
5. Class: _______________
8.Father's /Guardian's Ph. No. :
10.Personal Particulars :
(a) Height (in cms.) __________________________
(b) Weight __________________________
(c) Blood Group _________________
I declare that the information given is above is correct and accurate and undertake that I will follow the rules and
regulations of the academy.
I also undertake the responsibility of any injury / damage sustained during coaching sessions.
Date: _____________________
__________________
Signature of the Applicant
__________________
Signature of Father/Guardian