First Name^*

Middle Name^*

Last Name^*

Gender^*

Date of Birth^*

Blood Group^*

Community^*

Languages known^*

Mother Tongue^*

Residential Address^*

Correspondence Address^*

Distance from School (in kms)^*

Preferred Phone Number for School SMS^*

Emergency Contact No. (Res/Mobile)^*

Name of the person to be contacted^*

Relationship^*

FAMILY INFORMATION

Mother/Guardian:

Name^*

Age^*

Nationality^*

Educational Qualification^*

Institution^*

Occupation^*

Designation^*

Annual Income^*

Tel^*

Aadhar No^*

Office Address^*

Father/Guardian:

Name^*

Age^*

Nationality^*

Educational Qualification^*

Institution^*

Occupation^*

Designation^*

Annual Income^*

Tel^*

Aadhar No^*

Office Address^*

Email^*

Single Parent (Tick one, only if applicable)^*

Details of Brothers/Sisters of the student:

Incase of Staff Ward:

Name of the Parent:

B. DETAILS OF PREVIOUS STUDY

The Previous School Affiliated to:^*

Awards won so far in sports, arts or academics^*

MEDICAL HISTORY OF THE CHILD

HEARING:

Any Difficulty Observed:^*

Any Consultation with doctor done:^*

If Yes, Explain:

VISION:

Any Consultation with doctor done:^*

Use of Spectacles/Corrective Lenses:^*

MOTOR MILESTONES (Approx Months):

Sitting:

Standing:

Walking:

Speech:

Any medication taken for any medical conditions, Such as attention deficit / thyroid (hypo/hyper)/any other condition:

Any Medication taken for general well being:

Any Allergy / any medical information that school should be aware of:

C. ENCLOSURES (All Documents are mandatory at the time of admission)

D. MISCELLANEOUS

How did you hear about the Klorofeel School, Brahmapur^*

Amount