Delhi Public School, Electronic City

Survey No. 33, Bettadasanpura, Begur Hobli, Bangalore-560068 Karnataka, India. Tel: 9632190257 / 9902733314 Email: info@dpsecity.com / www.dpsecity.com / www.dpsecity.in

Please affix recent stamp size photograph of student

REGISTRATION FORM (2014 2015 Nursery V) Issue of Registration Form Does Not Ensure Admission
Registration No. (Office use) Onelearn No : (Office use) Name of the child (applicant)
(IN BLOCK LETTERS)

General Instructions
1. Use only Black ball Pen to fill the form 2. Do not enter registration number yourself 3. Use the codes given overleaf to fill locality code/ occupation code

Receipt No. (Office use) Date :

Male / Female (TICK)

Date of Birth (dd/mm/yyyy): (in words) Class to which Admission is sought Nationality Religion Blood group ___________________ Whether School Conveyance required: Please Tick ( Residential Address / Landline no:
Please give complete postal address

Age as on 30th June 2014 Mother tongue Please Tick ( ) SC/ ST/ OBC / Others: [Please Specify] Second language (for UKG V)__________________ ) Yes No

Pin Code:

Locality Code
(Codes see overleaf)

Distance from school (in Kms _____(Codes see overleaf) Preferred Phone Number for School SMS Sibling Yes No Siblings Name
(Studying in DPS, Electronic City)

If yes, give details (only of real brothers/sisters)

Class-Section

Admission No

Yes No School Staff Yes No School Alumni (DPS) Please fill details (i) Year of studying from :-________ to ________ (ii) Branch / city of DPS:- _______________ {Please attach evidence} Child with special needs: Yes No Specify

Educational Qualification (Attach xerox copy) (Please specify) FATHER Name Qualification Occupation (For codes see overleaf) Organisation where working

MOTHER

:____________________________ _____________________________
:_________________________________ :_________________________________ :_________________________________ __________________________________ ___________________________________ ___________________________________

Designation Organisation Address

: :

Phone No Mobile No E-mail (in block letters)

: : : FATHER MOTHER

Single Parent Tick one, only if applicable If child is sponsored (Name of sponsoring agency) Permanent Address

D ECLARATION I|We hereby certify that the above information provided by me/us is correct and I/we understand that if the information is found to be incorrect or false, the ward shall be automatically debarred from selection/admission process without any correspondence in this regard. I/We also understand that the application /registration /short listing does not guarantee admission to my ward. I/we accept the process of admission undertaken by the school and I/we will abide by the decision taken by the school authorities. Name Signature Date : Father : Mother :
Previous School's information (not applicable for nursery):

Submitted Transfer Certificate : (Please

) Yes

No Principal

The school provides transport facilities but offers no guarantee that a seat in the school bus will be available when the buses are full to capacity / do not play in the area of your residence. It will be the responsibility of the parents / guardians to drop / collect the child from the specified bus stop. The child should be 3 + years of age as on 30th June 2014 for Nursery The registration made herein does in no way entitle the candidate to be admitted to the school. Incomplete / Invalid forms will be rejected.
Code ADV AWS ARC DEF BNK BUS CAC DOC EDU EMB FIN Occupation Advocate Airways Architect Army / Navy / Air Force Defence Services Bank Employee Business (specify) Charted Accountant Doctor Educationist Embassy Employee Financial Organisation Employee

Please attach the following: a) Photocopy of Birth Certificate issued by Municipal Corporation. b) 2 Latest passport size colour photographs. Locality Code O A B C D Distance From School 0-3 Km Above 3 Km up to 5 Km Above 5 Km up to 10 Km Above 10 Km up to 20 Km Above 20 Km

HTL CIV INT NWS MER OTH PVT PUB RWS SCT MIS

Hotel Civil Services International Organisation Journalist/AIR/Print Media Merchant Navy Others Private Service Employee Public Sector Employee Railway Employee Scientist None of the above

Brouchure fee: Enclose the demand draft in favour of Delhi Public School, Electronic City Applicant outside India: $75 Demand Draft No. Name of the Bank Date Office Use Only Cash / DD received from Amount Applicant within India: Rs. 600

Dated:

Signature