Nursery Admission Form - RD Rajpal School, Dwarka

FOR NURSERY / PRE-SCHOOL CANDIDATES ONLY
INSTRUCTIONS:
1.
APPLICATION FORM DULY FILLED IN ALL RESPECTS SHOULD BE SENT TO “R. D.
RAJPAL PUBLIC SCHOOL, SECTOR – 9, DWARKA, NEW DELHI – 110077”. LAST DATE FOR
SUBMISSION OF APPLICATION IS 05/01/2015 TILL 4:00 PM. INCOMPLETE FORMS ARE
LIABLE TO BE REJECTED WITHOUT ANY INTIMATION.
2. SUBMISSION OF APPLICATION DOES NOT GUARANTEE ADMISSION, WHICH WILL
DEPEND ON THE NUMBER OF VACANCIES.
3.
TO BE FILLED IN BLOCK LETTERS. PRESS “CTRL + S” KEYS TOGETHER TO SAVE FILLED
FORM. PRESS “CTRL + P” TO PRINT THE FORM.
4.
PLEASE ENCLOSE DULY ATTESTED PHOTOCOPIES OF THE FOLLOWING ALONG WITH
THE FORM:
a) BIRTH CERTIFICATE.
b) RESIDENTIAL PROOF.
c) SIBLING PROOF – FEE RECEIPT OR ID CARD ( IF APPLICABLE ).
5.
IF REQUESTED, THE SCHOOL WILL TRY TO PROVIDE TRANSPORT FACILITY BUT OFFERS
NO GUARANTEE FOR A SEAT IF THE BUSES ARE FULL. THE BUSES WILL PLY ON
EXISTING ROUTES ONLY.
6.
FORMS FOR EWS / DG CATEGORY ARE AVAILABLE SEPARATELY.
NURSERY ADMISSION CRITERIA
POINTS
A. DISTANCE UPTO 10KMS (AERIAL)
DISTANCE ABOVE 10 KMS
60
50
B. SIBLING CASE
20
C. FIRST BORN
10
D. GIRL CHILD
10
PRE-SCHOOL/NURSERY ADMISSION
CATEGORY
PERCENTAGE
SEATS
GENERAL
35%
42
SIBLING
20%
24
MANAGEMENT & STAFF
20%
24
EWS/ DG CATEGORY
25%
30
TOTAL
100%
120
AERIAL DISTANCE MAP
NURSERY REGISTRATION FORM
2015
AFFIX LATEST
PASSPORT SIZE
MOTHER'S PHOTOGRAPH
PHOTOGRAPH OF
THE MOTHER
AFFIX LATEST
PASSPORT SIZE
CHILD'S PHOTOGRAPH
PHOTOGRAPH OF
THE CHILD
2016
AFFIX LATEST
PASSPORT SIZE
PHOTOGRAPH OF
THE FATHER
FATHER'S PHOTOGRAPH
PERSONAL DETAILS OF CHILD
1.
FULL NAME _______________________________________________________________________________________
LAST
FIRST
MIDDLE
2.
NURSERY / PRESCHOOL
CLASS APPLIED FOR __________________________________
3.
GENDER
5.
DATE OF BIRTH (DD / MM / YYYY) _________________ 6. PLACE OF BIRTH______________________________
7.
CASTE (SC/ST/GENERAL) _________________________ 8. RELIGION ____________________________________
9.
ADDRESS _________________________________________________________________________________________
MALE
FEMALE
4. NATIONALITY ________________________________
______________________________________________________________
NEW DELHI
LOCALITY
1100
PINCODE______________
10. TELEPHONE (R)______________________________________
PARENTS’ INFORMATION
11. FATHER’S DETAILS
a)
NAME
_______________________________________________________________________________________
b) EDUCATIONAL QUALIFICATION ________________________________________________________________
c)
OCCUPATION _____________________________
d) DESIGNATION ________________________________
e)
COMPANY NAME _________________________
f) EMAIL ID _____________________________________
g) OFFICE ADDRESS ______________________________________________________________________________
h) TEL(O) ______________________
i) MOBILE _________________
12. MOTHER’S DETAILS
a)
NAME
______________________________________________________________________________________
b) EDUCATIONAL QUALIFICATION
_____________________________________________________________
c)
OCCUPATION ______________________________
d) DESIGNATION ________________________________
e)
COMPANY NAME _________________________
f) EMAIL ID _____________________________________
g) OFFICE ADDRESS ______________________________________________________________________________
h) TEL(O) ____________________
13. STAFF CASE?
YES
i)MOBILE _________________
NO
R. D. RAJPAL SCHOOL, SECTOR-9, DWARKA
SIBLING INFORMATION
14.
NAME
AGE
RELATION
SCHOOL NAME
CLASS
HEALTH INFORMATION
15. DOES YOUR CHILD HAVE ANY PHYSICAL / EMOTIONAL / MEDICAL CONDITION WHICH MIGHT REQUIRE
SPECIAL ATTENTION? IF YES, PLEASE SPECIFY _____________________________________________________
__________
16. BLOOD GROUP ______________________________
_______________________________________________
17. ALLERGIES TO FOOD OR MEDICINE (IF ANY) ________________________________________________________
18. HISTORY OF MAJOR ILLNESS (IF ANY) _______________________________________________________________
TRANSPORT
19. WHETHER SCHOOL BUS FACILITY REQUIRED?
YES
NO
IF NO, ARE YOU IN A POSITION TO PROVIDE SAFE TRANSPORTATION TO THE STUDENT TO AND FROM
THE SCHOOL? PLEASE SPECIFY _____________________________________________________________________
20. PAYMENT DETAILS
THROUGH
RS. 25/- IN FAVOUR OF " R. D. RAJPAL PUBLIC SCHOOL "
CHEQUE
CASH
CHEQUE NO. / DD NO. ________________
DEMAND DRAFT
BANK / BRANCH NAME ______________________________
POINTS
PLEASE TICK THE OPTIONS BELOW:
A.
SIBLING STUDYING IN R. D. RAJPAL PUBLIC SCHOOL?
B.
AERIAL DISTANCE
UPTO 10KMS (REFER MAP)
60
AERIAL DISTANCE
ABOVE 10KMS
50
YES
NO
20
C.
IS THE APPLICANT FIRST BORN?
YES
NO
10
D.
GIRL CHILD
YES
NO
10
DECLARATION
I HEREBY DECLARE THAT THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND
THAT IF ANY PART OF IT IS FOUND TO BE FALSE, THE ADMISSION OF MY WARD MAY BE CANCELLED AT ANY STAGE. I AM IN A
POSITION TO PAY THE PRESCRIBED FEES AND CHARGES. I HEREBY CERTIFY THAT MY WARD AND MYSELF SHALL FOLLOW ALL THE
RULES, REGULATIONS AND PROCEDURES AS LAID DOWN BY THE SCHOOL FROM TIME TO TIME.
DATE(DD/MM/YYYY):
PLACE:
SAVE FORM
SIGNATURE OF FATHER
PRINT FORM
MOTHER
NAME _________________________________________