Post graduation OR Professional

Degree

Graduation OR

Equivalent

Sr. Secondary School Examination 10+2 OR Equivalent

Secondary School examination

10th OR Equivalent

Delhi Public School, Bangalore - East Survey No.43/1B & 45, Sulikunte Village, Dommasandra Post Bangalore – 562 125 Tel: 27822260 / 27822261 27822263 Fax 27822597 E-mail: east@dpsbangalore.net www.dpsbangalore.net.

Please affix

recent stamp size photograph

of student

REGISTRATION FORM (2013 – 2014) (Nursery to Std. X) Issue of Registration Form Does Not Ensure Admission

General Instructions

1. Use only Black ball Pen to fill the form 2. Do not enter registration number yourself 3. Use the codes given overleaf to fill locality code/ occupation code

Registration No. Receipt No. (Office use)

Lyceum No : (Office use)

(Office use)

Date :

Name of the child (applicant) Male / Female (IN BLOCK LETTERS)

Date of Birth (dd/mm/yyyy):

(TICK)

(in words)

Class to which Admission is sought Age as on 30th June 2013

Nationality Mother tongue

Religion Please Tick ( ) SC/ ST/ OBC / Others: [Please Specify]

Blood group ___________________ Second language (for UKG – X)__________________

Whether School Conveyance required : Please Tick ( ) Yes No

Residential Address : Please give complete postal address

Pin Code : Locality Code : (See overleaf)

Distance from school ( in Kms) Preferred Phone Number for School SMS

Sibling Yes No Siblings Name

If yes, give details (only of real brothers/sisters)

Class-Section Admission No

School Alumni (DPS) Yes No School Staff Yes No

Child with special needs: Yes No Specify

Educational Qualification (Tick highest qualification only)

Father

Mother

Name :

Occupation :

Occupation Code : (For occupation codes see overleaf )

Designation :

FATHER MOTHER (If business - specify) (If business - specify)

Organisation Name :

Organisation Address :

Phone No :

Mobile No :

E-mail (in block letters) :

FATHER MOTHER

Single Parent Tick one, only if applicable

If child is sponsored (Name of sponsoring agency)

Permanent Address

D E C L A R A T I O N

I| We hereby certify that the above information provided by me/us is correct and I/we understand that if the information is found to be incorrect or false, the ward shall be automatically debarred from selection/admission process without any correspondence in this regard. I/We also understand that the application /registration /short listing does not guarantee admission to my ward. I/we accept the process of admission undertaken by the school and I/we will abide by the decision taken by the school authorities.

Date :

Name Signature

Father : Mother :

Previous School's information (not applicable for nursery):

Submitted Transfer Certificate : (Please ) Yes No

Admission In charge Principal

The school provides transport facilities but offers no guarantee that a seat in the school bus will be available when the buses are full to capacity / do not play in the area of your residence. It will be the responsibility of the parents /

guardians to drop / collect the child from the specified bus stop.

The child should be 3 + years of age as on 30 the June 2012 for Nursery The registration made herein does in no way entitle the candidate to be admitted to the school. Incomplete / Invalid forms will be rejected.

Please attach the following : a) Photocopy of Birth Certificate

issued by Municipal Corporation. b) 4 Latest passport size colour photographs.

Code Occupation ADV Advocate HTL Hotel Locality Distance AWS Airways CIV Civil Services Code From School ARC Architect

DEF Army / Navy / Air Force -

Defence Services

BNK Bank Employee

BUS Business(specify)

CAC Charted Accountant

DOC Doctor

EDU Educationist

EMB Embassy Employee

FIN Financial Organisation Employee

INT International Organisation

NWS Journalist/AIR/Print Media

MER Merchant Navy

OTH Others

PVT Private Service Employee

PUB Public Sector Employee

RWS Railway Employee

SCT Scientist

MIS None of the above

O 0-3 Km A Above 3 Km up to 5 Km B Above 5 Km up to 10 Km C Above 10 Km up to 20 Km D Above 20 Km

2013

Brouchure fee:

Enclose the demand draft in favour of

“Delhi Public School, Bangalore-East”

Applicant outside India: $75 Applicant within India: Rs. 600

Demand Draft No.

Name of the Bank

Date Amount

Office Use Only

Cash / DD received from

Dated: Signature