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DELHI PUBLIC SCHOOL, DIGBOI

Please affix
recent
passport
size photo

IOCL Township, Digboi, Dist : Tinsukia Assam - 786171
Tel: 03751264917, 03751265955 Fax : 03751266850
Email : dpsdig@rediffmail.com website : www.dpsdigboi.com

REGISTRATION FORM – 2015-2016
Registration No: ___________ Status : Day / Boarder [ Please  ]
No:________
(Office Use)

Receipt
(Office Use)

ISSUE OF REGISTRATION FORM DOES NOT ENSURE ADMISSION
Name of Child: ______________________________________________________
Female (Block Letters)

Male /

( Please Tick )

Date of Birth (dd/mm/yy): ____/____/______(in words)
______________________________________
Age as on 30 March 2015: _____________________ Class to which admission is
sought__________
th

Nationality of child : ____________________________________ Mother Tongue:
________________
Religion: ________________
General

Please Tick Appropriate Box:

SC

ST

OBC

Blood Group: ____________
LANGUAGE OPTIONS :
1. Option for Second Language for Classes I - IX (Please Tick)
Assamese
2. Option for Third Language for Classes VI - VIII (Please Tick)
Assamese
Sanskrit

Hindi
Hindi

Permanent Address: (Complete Postal Address)
_________________________________________
___________________________________________________________________________________
_______________________________________________________ Pin Code
___________________
Phone / Mobile No (s)
_________________________________________________________________
Please fill in the following
Mother

Name (Block Letters)
___________________________

Father

________________________

Academic Qualification ________________________ ___________________________ Occupation: ________________________ ___________________________ Organisation : ________________________ ___________________________ Designation ________________________ ___________________________ Office Address: ________________________ ___________________________ ________________________ ___________________________ Phone No/Mobile ________________________ ___________________________ E-mail: ________________________ ___________________________ Specimen Signature: ________________________ ___________________________ Areas in which you could contribute to enrich school life in terms of time. No Class / Section Particulars of Local Guardians (if any) Name:___________________________ Relationship ________ Address: ____________________________________________________________________________ ____________________________________________________________________________________ Phone: _________________________________________ Signature : __________________________ . name of the parent working at DPS. Kindly fill whichever is applicable to you: a) In case of staff child. Digboi: _____________________________ b) If any siblings (real brother or sister) are already studying in our school. skill etc Please Tick ( ( ) Cultural Medical Media Professional Sports Academics The following information is important for short-listing children. please fill in _____________________ Name of Child ________________ __________________ Adm.

Incomplete / invalid forms will be rejected. 2 passport size photos (if belongs to any specific caste) & Cast Certificate Name of school / Play school the child is attending: ________________________________________ The class in which the child is studying / has passed: ________________________________________ Mode of Transport :___________________________________________________________________ The child should be 3+ years of age as on 30th March 2015 for Nursery The registration made herein does in no way entitle the candidate to be admitted to the school. on accepting the registration form of my ward. Name: ___________________ Admission No.Enclosures: Please attach the following: Photocopy of Govt.) Cash / DD received from __________________________________________________________ Dated: ______________________ __________________________ Signature . Birth Certificate of child. 500/. ______________________________ Admission Date :___________________ Class _______________________________ Student Status :___________________ Brochure fee: Enclose the demand draft in favour of “Delhi Public School. I fully understand that the school.& for NRIs $25. is not bound to grant admission and I also agree that the decision of the Principal regarding grant of admission will be final and binding. Date: Guardian Signature of Parent / OFFICE USE ONLY Class/ Sec. DECLARA TION I hereby certify that the above information is correct to the best of my knowledge and belief. Further. Digboi” (Applicant within India: Rs.