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-1- [Admission No.

……………]
[For Office Use Only]

DELHI PUBLIC SCHOOL


R.K. PURAM, NEW DELHI
ENROLMENT FORM
(All the entries should be in capital letters only)

Full Name of the Student First Name :

Last Name :

Date of Birth (In Figures) : :

(D D) (M M) (YEAR)

(In Words) :
Last School Attended :

Transfer Certificate Submitted (Yes / No) :


(No admission will be regularized until Transfer Certificate (in original) is produced. In case of first admission in
Nursery, Prep and Class I, Birth Certificate in original issued from the Municipal Corporation is mandatory).

Nationality of Child Religion Sex (M / F)

Whether member of SC / ST / OBC / EWS & DG School Conveyance required or not: (Yes / No)

Father’s Details Mother’s Details

Father’s Name Mother’s Name


Academic Qualification Academic Qualification
Organisation Name Organisation Name
Designation Designation
Office Address Office Address

Office Tel.No. Office Tel.No.


Fax No. ____________ Mobile No. Fax No. Mobile No
Email ID Email ID

Permanent Residential Address Present Residential / Local Guardians Address


_______________________________________________ ________________________________________________
_______________________________________________ ________________________________________________
__________________________Pin __________________ __________________________Pin ___________________
Res. Tel. No. ________________________________ Res. Tel. No. _________________________________
Mobile No. __________________________________ Mobile No. __________________________________

We, hereby certify that the information given in this enrolment form is correct to the best of our knowledge and belief.

Date ……………………………… Signature of Mother Signature of Father


(OFFICE USE ONLY)

Admit in Class Section

Admission Incharge __________________________ Principal


-2-

Admission No. …………………

Full Name of the Student First Name :

Last Name :

Details of any sibling (real brother or sister) now in DPS R.K. Puram / East of Kailash / Vasant Vihar

Admn.No. Class/Sec. Name of the Child Name of the school

__________ ____________ _______________________ ______________________


__________ ____________ _______________________ ______________________

If you (parents) are an Alumni of DPS, R.K. Puram. Please mention the following:-

Admission No. Year of Passing Roll No. Relation with Child

DECLARATION

1. We, hereby, certify that the information given in this enrolment form is correct & valid.
2. Regarding date of birth and correct name
We hereby certify that the correct Date of Birth of my child / ward is _____ /_____ / ___________
(in words)________________________________________________________ and the correct
spelling of his / her name is __________________________________ (in Block Letters).

3. We, hereby, undertake to abide by all the notification / instructions / circulars issued by the head
of the school from time to time.

4. We further declare that we shall not make any request for a change either in the Date of Birth or
the spelling of his / her name.
We confirm the above declarations.

Date ……………………. Signature of Mother Signature of Father


…………………………………………………………………………………………………………………
INSTRUCTIONS

1. The School reserves the right to cancel the admission of the student if it is found that the
declaration / certificate submitted at the time of admission are found to be false / incorrect.
2. All disputes are subject to the jurisdiction of Delhi Courts only.
3. If at any stage after admission, it comes to our notice that any information concerning the
admission of the child has been withheld by the parents, or that incorrect information has been
given, the admission will be cancelled and the name struck off from the rolls.

Principal
UNDERTAKING

We ___________________________ & _____________________________


Parents of ____________________________ resident of ________________
______________________________________________________________
New Delhi ____________, certify that all the information provided by us for
admission to our ward to Delhi Public School, R. K. Puram / Vasant Vihar /
East of Kailash is correct and we understand that if the information is found
to be incorrect or false, our ward shall be automatically debarred from
selection / admission process without any correspondence in this regard. The
admission will also stand cancelled if the information provided is found to be
incorrect or false, at a later date.

We the parents also understand that the application / registration / short listing
does not guarantee admission to our ward.

We the parents accept the process of admission undertaken by the school


and will abide by the decision taken by the school authorities.

__________________________ ____________________________
(Father’s Name & Signature) (Mother’s Name & Signature)

Date: _________________________
DELHI PUBLIC SCHOOL, R.K.PURAM
HEALTH CERTIFICATE

1. Name of the Child :___________________________________________


2. Class / Section :___________________________________________
3. School :DPS Vasant Vihar / DPS East of Kailash / R K Puram
4. Date of Birth :___________________________________________
5. Father’s Name :___________________________________________
6. Address with Telephone No. :___________________________________________
___________________________________________
7. Immunization History :
a) BCG : Yes / No_____________
b) DPT : Yes / No_____________
c) Oral Polio : Yes / No_____________
d) Measles / MMR : Yes / No_____________
e) Hepatitis B : Yes / No_____________
f) H Influenza B : Yes / No_____________
g) Typhoid : Yes/ No _____________

Vaccines No. (a) to (g) are compulsory.


It is, however, recommended that the following vaccines may be given too:
Hepatitis A, Meningococcal, Influenza virus, Pneumococcal, Chicken Pox

8. History of past illness :-


a) Specific diseases suffered in the past. : ________________________
b) Operation(s) undergone in the past, if any. Specify. : ________________________
c) Allergies, if any. : ________________________
d) Any other disease or problem for which the child is on regular medication:
__________________________________________________________________
e) Any Congenital Anomaly : _________________________________________

Date : Signature of the Parent


Medical Certificate of fitness : (From Child’s Regular Doctor)

This is to certify that I, Dr. _________________________________________________ have


examined _____________________________ aged _________ years, D/o, S/o __________________
on (date) ____________.
His / Her visual acquity is normal / corrected with glasses. There is no other illness, which would
render the child unfit to join the school. He / she is fit / unfit to join the school.

Signature of Doctor
Name : ____________________________
Regn.No. ___________________________
-----------------------------------------------------------------------------------------------------------------------------------------
MEDICAL CERTIFICATE BY SCHOOL DOCTOR

Certified that I have examined Master / Miss ______________________________________________


and he / she is medically fit / unfit for admission in the School.

Date :- ______________ Signature of Medical Officer


DPS R.K. Puram
DELHI PUBLIC SCHOOL
SECTOR-12, R.K. PURAM, NEW DELHI-110022
Branch - R. K. Puram

Pay-in-Slip (Admission Deptt.Copy) Class: _______ Client Code: DPSRKCOLL

Admission Number Student's Name

Father's Name Mother's Name


Father's Mobile No. Mother's Mobile No.
PO/DD/Cheque No. Dated
Bank Name Amount

DELHI PUBLIC SCHOOL


SECTOR-12, R.K. PURAM, NEW DELHI-110022
Branch - R. K. Puram

Pay-in-Slip (Cashier Copy) Class: _______ Client Code: DPSRKCOLL

Admission Number Student's Name

Father's Name Mother's Name


Father's Mobile No. Mother's Mobile No.
PO/DD/Cheque No. Dated
Bank Name Amount

DELHI PUBLIC SCHOOL


SECTOR-12, R.K. PURAM, NEW DELHI-110022
Branch - R. K. Puram

Pay-in-Slip (Bank Copy) Class: _______ Client Code: DPSRKCOLL

Admission Number Student's Name

Father's Name Mother's Name


Father's Mobile No. Mother's Mobile No.
PO/DD/Cheque No. Dated
Bank Name Amount

DELHI PUBLIC SCHOOL


SECTOR-12, R.K. PURAM, NEW DELHI-110022
Branch - R. K. Puram

Acknowledgement-Slip (Parents Copy) Class: _______ Client Code: DPSRKCOLL

Admission Number Student's Name

Father's Name Mother's Name


Father's Mobile No. Mother's Mobile No.
PO/DD/Cheque No. Dated
Bank Name Amount