Form - Summer Camp 2015F - Lakshmibai National Institute of

SUMMER COACHING CAMP
7th MAY to 20th JUNE, 2015
Organized by
Lakshmibai National Institute of Physical Education, Gwalior
(Declared under Section 3 of the UGC Act, 1956 vide GOI, Ministry of HRD Notification No. F. 9-14/92-U.3 dated 21.9.1995)
Name of the Game……………………………..……………………………
Paste one
photograph of
the candidate
To
The Registrar,
LNIPE, Gwalior.
Sir,
I,………………………………………………… S/O/D/OShri, ……………………………………….......................
of.................................................................. School studying in Class ………….….. wish to join the Summer
Coaching Camp during the Month of May-June, 2015. I have gone through the rules and conditions for this camp
and accept to abide by them strictly. I have got my application forwarded and signed by my parents/guardian as a
token of acceptance of the terms and conditions of the membership.
Signature _______________________
(STUDENT)
Master/Kumari (NAME IN CAPITAL LETTERS) ………………………………………………………… is my
son/daughter. I am sending my son/daughter AT MY OWN RISK and the Institute will not be held responsible for any
accident.
Signature_________________________
(PARENT/GUARDIAN)
1.
Full Name (in block letters)
:
______________________________________________
2.
Date of Birth (In Figures)
:
______________________________________________
3.
Age (on 1st May, 2015)
:
______________________________________________
4.
Sex
:
Male/Female
5.
Name of the Parent/ Guardian
:
______________________________________________
6.
Occupation
:
______________________________________________
7.
Residential Address
:
______________________________________________
______________________________________________
______________________________________________
8.
Telephone No. (Office/ Res./Mob.) :
______________________________________________
Note: Photocopy of Birth Certificate must be enclosed alongwith the form. For games/sports where there is no age bar and the birth certificate is not required.
One passport size Photograph should be attached and one should be pasted above in the space provided, Read other rules and conditions overleaf.
FOR OFFICE USE ONLY
Receipt No. ______________
Date: ______________
Charges paid Rs__________________
Signature of the Cashier __________________
Last date to submit Form :- 06th MAY, 2015
नोट: आवेदन प
के साथ दो फोटो एवं ज म त थ
माण-प
क छाया त लगाये
TERMS AND CONDITIONS
1.
The students must get all the details in the application form completed before admission. Incomplete forms
will not be accepted.
2.
The fees shall be charged as applicable for the activities mentioned below.
3.
Though the Institute will take all precautions and care for the safety of the participants. However, THE
INSTITUTE WILL NOT BE HELD RESPONSIBLE FOR ANY ACCIDENT.
4.
The students must get the photograph self attested and the application forwarded and signed by
Parents/Guardian. The students will have to produce the original Birth Certificate at the time of admission
alongwith ONE EXTRA PASSPORT SIZE PHOTOGRAPH FOR THE IDENTITY CARD SHOULD BE
ATTACHED ALONGWITH THE APPLICATION FORM.
5.
The students must be regular and punctual otherwise his/her name will be struck off, if he/she is absent for 3
consecutive classes without prior permission.
6.
The students must maintain discipline and follow all the instructions given by the teachers regarding safety
and hygiene.
7.
The membership will remain provisional and can be cancelled at any time by the staff in charge without
assigning any reason.
8.
The complete form in all respects should be submitted in the Institute Extramural Directorate however, the
fees should be deposited in the Account Section of the Institute as all working days.
9.
The training will remain suspended on SATURDAY, SUNDAY AND OTHER PUBLIC HOLIDAYS.
10.
Money once deposited is not refundable.
11.
The details of activities, age limit and their charges are as follows:
S.No.
Game Name
Age
Fees
Date
Time
1
Cricket
08 to 19 Years
1400/- 07.05.15 to 20.06.15 6 am to 8 am
2
Tennis
08 to 19 Years
1400/- 07.05.15 to 20.06.15 6 am to 8 am
3
Football
08 to 19 Years
1200/- 07.05.15 to 20.06.15 6 am to 8 am
4
Basketball
08 to 19 Years
1200/- 07.05.15 to 20.06.15 6 am to 8 am
5
Music
08 to 25 Years
800/07.05.15 to 20.06.15 6 am to 8 am
6
Skating
05 to 19 Years
1200/- 07.05.15 to 20.06.15 6 am to 8 am
7
Yoga
No Age Bar
1000/- 07.05.15 to 20.06.15 6 am to 8 am
8
Squash
08 to 19 Years
1200/- 07.05.15 to 20.06.15 6 am to 8 am
9
Badminton
08 to 19 Years
1400/- 07.05.15 to 20.06.15 6 am to 8 am
10
Table Tennis
08 to 19 Years
800/07.05.15 to 20.06.15 6 am to 8 am
11
Physical Fitness & Weight Training No Age Bar
1000/- 07.05.15 to 20.06.15 6 am to 8 am
12
Aerobics
No Age Bar
1000/- 07.05.15 to 20.06.15 6 am to 8 am
13
Gymnastics & Trampoline
05 to 19 Years
1000/- 07.05.15 to 20.06.15 6 am to 8 am
14
Physical Fitness (Special)
No Age Bar
2200/- 07.05.15 to 20.06.15 6 am to 8 am
15
Volleyball
08 to 19 Years
600/07.05.15 to 20.06.15 6 am to 8 am
16
Athletics
08 to 19 Years
800/07.05.15 to 20.06.15 6 am to 8 am
17
Judo
08 to 19 Years
800/07.05.15 to 20.06.15 6 am to 8 am
18
Adventure Sports
08 to 19 Years
800/07.05.15 to 20.06.15 6 am to 8 am
19
Hockey
08 to 19 Years
600/07.05.15 to 20.06.15 6 am to 8 am
20
Rifle/Pistol Shooting
08 to 19 Years
1500/- 07.05.15 to 20.06.15 6 am to 8 am
Note: All the students will assemble in the Cricket Ground on 07.05.15 at 6.00 AM.
12.
13.
14.
15.
All the children will report for the camp in proper dress/kit prescribed for each game.
Cricket Bat, Hockey Stick, Badminton Racket, Tennis Racket, Table Tennis Bat, Squash Racket, Skates,
Judo Dress, Synthesizer, Octopad, Guitar will not be provided by the Institute.
The safety gadgets (in whatever activities it is required) should also be brought by the candidates.
The activities will be organized subject to the administrative feasibility.