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Last Name
Last Name
Data Of Birth
Age
Gender
Phone
Residential Address Of Child
Name Of Parent/Guardian
Business Name
Business Address
Occupation
Phone Number
Who will be responsible for the child's educational and other fees?
State
Home Address
Name Of Last School
Address Of Last School
Last Class Completed
Year
Reason For Transfer
Attach copy of transfer certificate from last school
Immunization
Yes
No
B.C.G
D.P.T
Oral Polio
Measles
Any Handicap?
Yes
No
Any Form Of Allergy
Yes
No
Does Your Child Wear Eye Glasses
Yes
No
Incase Of emergency please contact
Acceptance
Declaration I/We the parent/guardian of this child, do here by declare that all the information provided above about my/ our child/ ward are true and correct to the best of my / our knowledge.
Today's Date
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