GYAN DEEP SR. SEC. SCHOOL SHEETLA COLONY, GURUGRAM

(CBSE AFFILIATION NO. 530695)

Admission Form

Admission no.:________________

1. Full name of the Student:____________________________________________________________________

2. Date of Birth(in figures)_________________________________________ _____(Attach Birth Certificate/T.C.)

(in words)____________________________________________________________________

3. Place of Birth of the Student __________________Distt.:__________________ State:___________________

4. Class to which Admission sought:_____________________________________________________________

5. Father’s Name:_______________________________ Mother’s Name:_______________________________

6. Qualification of (a) Father:____________________ (b) Mother:_____________________________________

7. Occupation of (a) Father:_____________________ (b) Mother:_____________________________________

8. Annual Income of (a) Father:_________________ (b) Mother:_____________________________________

9. Contact No. of (a) Father:____________________ (b) Mother:_____________________________________

10. Aadhar Card No. of (a) Father:________________ (b) Mother:___________(c) Student ________________

11. Religion:_____________________ Nationality :___________________ Caste:_________________________

12. Permanent Address:________________________________________________________________________

____________________________________________________________________________________________

13. Present Address:____________________________________________________________________________

____________________________________________________________________________________________

14. Do you belong to Schedule Tribe/Schedule Caste/Backward Class?if yes, State:_________________________

15. Does the student has a Bank Account(Yes/No):___________________________________________________

16. If ’Yes’ give the Name of the Bank:____________________________________________________________

Account No.:______________________________________IFSC CODE:_______________________

17. Do you want to avail the School conveyance for the Student(Yes/No):________________________________

18. If ‘Yes’ mention the Pick up point:____________________________________________________________

19. Details of Siblings studying in the school_______________________________________________________

(a) Name of Brother /Sister :________________________________________(b) Class & Section:_________

21. Name of the previous school:_________________________________________________________________

22. Is it a recognized school(Yes/No):_____________________________ state the Board:___________________

23. Sr. No of T.C.________________ Date of Issue of T.C.____________________________________________

Please Turn Over

PHOTO

Only for Class 10+1

24. Group opted (Science/Commerce/Humanities):___________________________________________________

25. Subjects opted: 1.:___________________2.:______________________3.:_______________________

4.:___________________5.:____________________6.:(Optional)_________________

26. Particulars of Exam passed:

(a) Board:_________________________ (b) Year/Session:___________________________

(c) Roll No.:________________________

Note: Admission is provisional and be regularized as per CBSE norms after the declaration of 10th

result.

I hereby certify that the above particulars are correct to the best of my knowledge and I shall not ask for any

change in future. I further certify that I have read and understood the school regulations and agree abide,

admission will be automatically cancelled in case of violation of the school rules.

Disclaimer: Admission is provisional and be regularised as per CBSE norms. School is not , in any way,

responsible of any rejection by the CBSE.

Date:________________________________ Signature of Parent /Guardian

Name:_____________________

Note : Admission ,if any , to 10th

and 10+2 classes will be provisional and be regularized only by the

Central Board of Secondary Education.

Please attach the following documents:-

1. Birth Certificate.

2. TC from a recognised school/Affidavit.

3. Copies of the Aadhar Card of Student/Mother/Father.

4. Copy of the 1st Page of Bank Pass Book.

5. Properly filled Medical Form.

All documents should be self attested.

ORDER Admit Master /Miss______________________________S/O/D/O/Sh._____________________________________

to Class_____________________________

Date:_______________________________ Principal/Manager

1. Relevant Entries have been made in the Admission/Withdrawal register.

2. All documents checked and cleared for admission.

Date:_______________________________ Admission In-Charge

MEDICAL RECORD OF THE CHILD

(To be filled by the Parents/guardian in capital Letters)

Name:__________________________________________ Class/Section:______________Sex: M/F

Date of Birth_______________ Adm. No.__________Blood Group___________________________

Father’s Name:_____________________________________________________________________

Address:___________________________________________________________________________

__________________________________________________________________________________

Emergency Contact. No.______________________________________________________________

Specific Disease/Surgery suffered in the past

__________________________________________________________________________________

__________________________________________________________________________________

Any disease for which the child is on regular medication and details of medication:-

__________________________________________________________________________________

__________________________________________________________________________________

Has your child ever been hospitalized? (If yes , Mention)

__________________________________________________________________________________

Any Deficiency /Allergies if any:

Food/Drinks________________________________________________________________________

Medicines__________________________________________________________________________

__________________________________________________________________________________

Signature of Parent/Guardian

__________________________________