GENESIS School Transport GLOBAL SCHOOL & Declaration Form Name of the Scholar Grade Affix scholar's Admission Number photo here Facility opted for Day After School Programme 5 Day Residential 7 Day Residential Subsequent to my wards admission to Genesis Global School, request the School, th my chile of Grade may please be allowed! to avail the transport facility being provided by the school at the set rates. Although, lunderstand that the schoo! will provide full security and safety, exercising due diligence in carrying out the service, the schoo! shall not be held responsible in case of any mishap. lalso understand that the school reserves the ight to alter/modify/res uicture any route, ;Ry point of time in the interest of children and school, as well agree to abide by all the rules and regulations laid down by the School Authorities, Name of Parent Address Telephone Nos. Date Parents’ Signature For Office Use Only Route No. (Piek-U Pic YP) Bus Fee Paid No Yes Route No. (Drop) Facility paid for Day After School Programme 5 Day Residential 7 Day Residential Transport Department Signature Account’s Department SignatureGENESIS GLOBAL SCHOOL, ID Card / Escort Card Form Name of the Scholar Grade Admission Number Facility opted for Day 5 Day Residential After School Programme 7 Day Residential th The ese: Allescorts besides the parents fort should be 18+ years old ople are authorised to escort the scholar to & from th Bus stop/Schooh must have a photo ID attached along with this form. x Mother's Passo size photo here Name Name Name Name Phone No. Phone No. Phone No. Phone No. Relation Relation Relation Relation Date Parents’ Signature Parents’ Name For Office Use Only Date of receiving the form Received byGENESIS GLOBAL SCHOOL, Medical History Form Name of the Scholar Grade Admission Number Weight Height Blood Group Important We request you to he completely thorou jenesis Global School. Many scholars ove lety of aland psychological difficulties which have not, in any way, interfered with their success at Genesis Global School, however, for the scholar’s own safety and health, Ist be aware of s nin providing information nprol hat applies to your ward ents, including date condition, medication and current status of the condition, Use additional pages or support the document with calreports, ifnecessary, and provide det Has your ward ever suffered from? 1. Asthma / Wheezing Ives, please give details (Ne Lives 2. Bleeding Disorder IFyes, please give details CNo Dyes 3. Diabetes Iryes, please give details, CNo Dyes 4. Epilepsy / Convulsions Ityes. lease give details, (Ne Lives 5. Blood Pressure IFyes, please give details CNo Dyes 6. Migraine / Headache Iryes, please give details, CNo Dyes 7. Syncope / Fainting Ives, please give details (Ne Lives 8. Heart Problem IFyes, please give details CNo Dyes 9. Eye Problem e details, Ityes, please gi CNo DyesGENESIS Medical History Form GLOBAL SCHOOL, 10, Hearing Problem Cine LD Yes ityes, please give details Tl, Ankle /Knee / Joint Problem (ne Lives Iryes, please give details, 12, Frequent infections of a. Ear (ne Lives Ives, please give details, b. Throat /Tonsils [Ne Lives IFyes, please give details c. Sinuses Cine LD Yes Ityes, please give details 13, Does your child have any special / restricted Dietary Needs? (ne Lives (Please attach a photocopy of the Diet Chart) IFyes, please give details, 14, Has your ward been hospitalized within the last 3 years? Cine LD Yes Ifyes, please give details, 15, Has your ward suffered from Typhoid / Jaundice in the last 3 years? (ne Lives Ityes, please give details, 16, Has your ward been exposed to Tuberculosis in the last 3 years? [Ne Lives IFyes, please give details, 17. 1s your child allergic to: a. Bee Sting / Insect Bite [Ne Lives ifyes, please give details b. Any Medicine Cine LD Yes ifyes, please give details ©. Food tem (ne Lives Ityes, please give details, 18, Is your ward taking any mediation? [Ne Lives IFyes, please give details,GENESIS Medical History Form GLOBAL SCHOOL, 19. Can the following medications be given to your ward, in case of an emergency’ a. Paracetamol /Crocin (Ne [ves iF no, please give details b. Anti- Histamine / Anti-Allergic LNe Lives IF no, please give details €. Antacids /Digene [Ne [ves IF no, please give details 4d. Non-steroidal anti-inflammatory (Ne [ves iF no, please give details Any injections (only in case of an emergency) LNe Lives IF no, please give details 20. Does your ward require Glasses or Contact lenses? [Ne [ves ityes, please give details 21, Has your ward been immunised as per the schedule? (Ne [ves (Please attach a photocopy of the Immunisation Card) 22. 1s your ward taking any medications? (Ne [ves (Please a copy of the Doctor's prescription) Medical Certificate This is to certify tha Doctors’ signature lame & Stamp with Regn.No} have examined of Grade Age Date {and found that he/she is not suffering from any Thrcenteate as tobe slonedby Rese. MBBS Doctor. chronic/contagious disease. For Office Use Only Date of receiving the form Received byGENESIS Swimming Consent Form GLOBAL SCHOOL, Name of the Scholar Grade Affix scholar's Admission Number photo here Facility opted for Day After School Programme 5 Day Residential 7 Day Residential Ve, Mr. /Mrs. studying in Grade of Genesis Global School, Noida, i hereby give my willing consent far my ward to u uillnot hold the School responsible for any accident vimming pool. hat may inadvertently occur during the ourse of such use and swimming activity. Date Parents’ Signature Parents! Name Woo haaeavotgmane = eee Medical Certificate This is to certify tha Doctors’ signature (Name & Stamp with Reg No) have examined of Grade Age Date and found that he/she is not suffering from any chronic/et prevents him/her from attending the swimming cl ious disease or any disability For Office Use Only Date of receiving the form Received byGENESIS Guardian Information Form GLOBAL SCHOOL, (To be filled by Scholars applying for 7 day Residential facility only) Guardian's Name Address Affix guardian's oto here Home Phone Number Business Phone Number Mobile Phone Number E-Mail 1D. parent's of has authorised me to be the local guardian til further notice V/We will be responsible for any enquiry, special permissions, any field trips and medical welfare of the lar as well as the safety and development of VWe will also undertake respe te him/her in case of any suspension Guardian's Name Parents’ Name Signature Signature Date Date Please attach proof of ID ie, relevant passport page or driving licence, and valid Indian visa and residence permit. For Office Use Only Date of receiving the form Received by