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Delhi Public School, Bangalore - North Please affix

Survey No. 35/1 'A', Sathanur Village, Bagalur Post, Off Bellary Road recent stamp
Bangalore North - 562 149 Karnataka, India. Tel: 2847 8041 / 42 / 43 size photograph
Email: north@dpsbangalore.net www.dpsbangalore.net www.dpsblr.com of student

General Instructions
REGISTRATION FORM 1. Use only Black ball Pen to fill the form
Issue of Registration Form Does Not Ensure Admission 2. Do not enter registration number yourself
3. Use the codes given overleaf to fill locality code/ occupation code

Registration No. Receipt No.


(Office use) (Office use)
Lyceum No : Date :
(Office use)
Name of the child (applicant) Male / Female
(IN BLOCK LETTERS) (TICK)

Date of Birth (dd/mm/yyyy):

(in words)

Class to which Admission is sought Age as on 30th June 2010

Nationality Mother tongue

Religion Please Tick ( ) SC/ ST/ OBC / Others: [Please Specify]

Blood group Second language (not applicable for nursery)

Whether School Conveyance required : Please Tick ( ) Yes No

Residential Address :
Please give complete postal address

Pin Code : Locality Code :


(See overleaf)

Distance from school ( in Kms) Preferred Phone Number for School SMS

Sibling Yes No Siblings Name

If yes, give details Class-Section Admission No


(only of real brothers/sisters)

School Alumni (DPS) Yes No School Staff Yes No

Child with special needs: Yes No Specify

Educational Qualification Post graduation Graduation Sr. Secondary Secondary School


(Tick highest qualification only) OR OR School Examination examination
Professional Degree Equivalent 10+2 OR Equivalent 10th OR Equivalent

Father
Mother

FATHER MOTHER
Name :

Occupation :

Occupation Code :
(For occupation codes (If business - specify) (If business - specify)
see overleaf )

Designation :
Organisation Name :

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

DECLARATION
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

Admission In charge Principal / Headmistress


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 ply 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 30 the June 2010 for Nursery Please attach the following :
The child should be 4 + years of age as on 30 the June 2010 for LKG a) Photocopy of Birth Certificate issued
The registration made herein does in no way entitle the candidate to be admitted to the school. by Muncipal Corporation.
Incomplete / Invalid forms will be rejected. b) 4 Latest passport size colour photographs.
Code Occupation
ADV Advocate HTL Hotel Locality Distance
AWS Airways CIV Civil Services Code From School
ARC Architect INT International Organisation
DEF Army / Navy / Air Force -
O 0-3 Km
NWS Journalist/AIR/Print Media
Defence Services A Above 3 Km up to 5 Km
MER Merchant Navy
BNK Bank Employee
OTH Others B Above 5 Km up to 10 Km
BUS Business(specify)
CAC Charted Accountant PVT Private Service Employee
DOC Doctor PUB Public Sector Employee C Above 10 Km up to 20 Km
EDU Educationist RWS Railway Employee D Above 20 Km
EMB Embassy Employee SCT Scientist
FIN Financial Organisation Employee MIS None of the above
Brouchure fee:
Enclose the demand draft in favour of
“Delhi Public School, Bangalore-North. Bangalore”

Applicant outside India: $75 Applicant within India: Rs. 600

Demand Draft No.

Name of the Bank

Date Amount

Office Use Only

Cash / DD received from

Dated: Signature

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