Delhi Public School, Bangalore - East

Survey No.43/1B & 45, Sulikunte Village, Dommasandra Post Bangalore 562 125 Tel: 27822260 / 27822261 27822263 Fax 27822597 E-mail: east@dpsbangalore.net www.dpsbangalore.net.

Please affix recent stamp size photograph of student

REGISTRATION FORM (2013 2014) (Nursery to Std. X) Issue of Registration Form Does Not Ensure Admission
Registration No. (Office use) Lyceum 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 :
Please give complete postal address

Age as on 30th June 2013 Mother tongue Please Tick ( ) SC/ ST/ OBC / Others: [Please Specify] Second language (for UKG X)__________________ ) Yes No

Pin Code : Distance from school ( in Kms) Sibling Yes No

Locality Code :
(See overleaf)

Preferred Phone Number for School SMS Siblings Name Class-Section Admission No

If yes, give details (only of real brothers/sisters) School Alumni (DPS) Child with special needs: Yes Yes

No No Specify

School Staff Yes

No

Educational Qualification (Tick highest qualification only)

Post graduation OR Professional Degree

Graduation OR Equivalent

Sr. Secondary School Examination 10+2 OR Equivalent

Secondary School examination th 10 OR Equivalent

Father Mother FATHER Name Occupation Occupation Code

(For occupation codes see overleaf )

MOTHER

: : :
(If business - specify) (If business - specify)

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

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

Admission In charge

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.
2013 for Nursery The child should be 3 + years of age as on 30 the June 2012 The registration made herein does in no way entitle the candidate to be admitted to the school. Incomplete / Invalid forms will be rejected.

Please attach the following : a) Photocopy of Birth Certificate issued by Municipal Corporation. b) 4 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

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

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, Bangalore-East 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