Registration No……………………. MODERN CHILD PUBLIC SCHOOL (Senior Secondary & Affiliated to All India CBSE) Punjabi Basti, Nangloi, Delhi-110041 Ph: 011-25473035,25471231.Fax: 011-25471231 E-mail: [email protected] Visit Us: www.mcpsonline.com PASTE PHOTO HERE REGISTRATION FORM FOR NURSERY 2015-16 (FILL IN BLOCK LETTERS) 1. Name of the Child: ………………………………………………………………………………………………….………….………… 2. Date of Birth in Words: ………………………………………………………….…………………………………….…..….………. 3. In Figures……………………………………………………… Age as on 31-03-2015…………………………………………….. Place of Birth: ………………………………………………………………………………………………………………..…………….. 4. Sex: Male ( 5. Nationality and Religion: ……………………………………….… 6. Category (General/SC/ST/OBC): …………………………………… 7. Physically Handicapped Yes ( 8. Details about Parents: ) Female ( ) ) No ( ) If Yes, Type of Disability: ………………….….….………… (A) Father’s Name: …………………………………………………………………………………………………………….…………….. Educational Qualification: ……………………………………………………………………………………….….………………... Occupation/ Profession and Designation………………………………………………………………………....……………. Office Address…………………………………………………………………………………………………………….…………..……. ………………………………………………………………………………………………… Ph………………………….…….….…….... Present Address: ………………………………………………………………………………………………….…………….…..….… …………………………………………………………………………………………………..Ph…….…………………….………………... Permanent Address : …………………………………………………………………………………………….…….……………….. ………………………………………………………………………………………………..…Ph….……………………….…….………….. Monthly Income ……………………………………………………………. (B) Mother’s Name: ……………………………………………………………………………….…………………………………..…… Educational Qualification : ……………………………………………………………………………………………………….….. Occupation/ Profession and Designation…………………………………………………………………………….…………. Office Address…………………………………………………………………………………………………………………….….….…. ………………………………………………………………………………………………… Ph…………………………….…….….…….. Present Address : ……………………………………………………………………………………………………………..……….… …………………………………………………………………………………………………..Ph….………………………….…….……….. Permanent Address : ……………………………………………………………………………………………………….………..… ………………………………………………………………………………………………..…Ph……..………………………….…………. Monthly Income ………………………………………………….…..….. ( C) Guardian (If different from parent) Educational Qualification: …………………………………………………….………………………………………………..…….. Occupation/ Profession and Designation…………………………………………………………………………………..……. Office Address……………………………………………………………………………………………………………………….………. …………………………………………………………………………………………………. Ph………………………………….….…….... Present Address: ………………………………………………………………………………………………………..………..……….. ……………………………………………………………………………………………….…Ph……………………………………….……... Permanent Address: ……………………………………………………………………………………………………….…….…..…… …………………………………………………………………………………………….……Ph…………………………………….…….….. Monthly Income …………………………………….….…… 9. (a) Distance from School ………………………….……… (b) Total siblings ……………………… How many Studying in this school………………………………………….……. (c) Girl Child/First Child ………………….………..……… (d) Alumni: Father/Mother/Both ……………….….…. (e) Transfer Case of Parents. Yes ( 10. ) No ( ). If yes, from ……………..…………………………….….... Previous education of the child (If Any) …………………………………………….………………….………….……..…… Name of the School last attended …………………………………………………..………………….……….…..………….. Note: The parents must come to the school personally to admit their ward. UNDERTAKING Certified that the information given in the application is true to the best of my knowledge. Certified that I shall abide by the rules as laid down by the school from time to time, if my child is admitted. Date…………………………………. Signature of parent/Guardian Principal _______________________________________________________________ DOCUMENTS REQUIRED FOR ADMISSION 1. Birth Certificate ( Minimum age required as on 31 March 2015 should be 3+ Years) 2. Two Photos of the Child 3. I.D. Proof of Parents 4. Residence Proof 5. Vaccination Card