BALJYOTI

C/o ST. JOSEPHS ACADEMY

PHOTO

Savita Vihar, Delhi-110092

(A Minority Institution)

Registration Form for 2015-2016 for Pre-School (LKG)

(Age: The Child shall have completed 3 years on 31st March, 2015)

S. No. ....................

PSR No. .............................

1. Name of the Student (in block letters) .........................................................................................

2. Gender

Male /

Female

3. Mother Tongue ..............................................................................................................................

4. Date of Birth Date ............................... Month ............................... Year....................................
5. Nationality .....................................................................................................................................
6. Religion ............................ If Christian
Catholic
Others
(NB: Attach letter of Parish Priest/Pastor)
7. Fathers Name ...............................................................................................................................
Office Address ...............................................................................................................................
E-Mail (if any) ......................................................................... Phone :.........................................
8. Mothers Name...............................................................................................................................
Office Address................................................................................................................................
E-Mail (if any) ......................................................................... Phone :.........................................
9. Guardians Details...........................................................................................................................
10. Residential Address (Delhi) ............................................................................................................
................................................................................................. Phone :.........................................

INFORMATION ON SCHOOL SPECIFIC PARAMETERS :
11. NEIGHBORHOOD : Distance from the school in Savita Vihar (in Kms) ........................................
(NB: Distance fixed by the school will be final).
12. Whether child of ALUMNI
Yes
No
If 'Yes furnish Details Father : Year of passing out .....................

Class .....................

Mother : Year of passing out .....................

Class .....................

13. SIBLING (Whether real Brother/Sister currently studying in St. Josephs Academy)

Yes

No

If 'Yes, Name ......................... Adm. No. ........... Class ..... Section.

14. Whether GIRL CHILD
Yes
No
15. Whether child of SINGLE PARENT
Yes
No
If yes, attach the relevant documents. (Divorcee/Widow/Widower/Spinster)

BALJYOTI
C/o ST. JOSEPHS ACADEMY
Savita Vihar, Delhi-110092
(A Minority Institution)

Acknowledgement
Registration Form for 2015-2016 for Pre-School (LKG)
(Age: The Child shall have completed 3 years on 31st March, 2015)

PSR No. .............................

Received registration form of ...................................................... for admission to class Pre-school (LKG)
for the session 2015-2016.
Result on 2nd March 2015 at 4:00 p.m.
Date ...................................

NB: Attach copies of :

1. Birth certificate of the child
2. Residential proof (Ration card/Election ID card/Passport/Driving License, Rent Deed attested by
SDM/Adhaar card/UID card/Electricity bill/MTNL telephone bill/water bill/issued in the name any of
the parent/Domicile certificate of child or his/her parents).
Please register my son/daughter/ward name above in your Pre-school (LKG) BALJYOTI, which will
function from VIII/54, Jwalanagar, Shahadara, Delhi-110032 from 2 p.m. to 5 p.m. I shall produce
the originals of the requisite documents at the time of admission for verification.
Return this Form duly filled from 13.01.15 to 20.01.15 on all week days
(As mentioned on the school Notice Board)

Declaration:
I.

father/mother/guardian of.. hereby

declare that the information given above are based on facts and authentic records. Admission of
my child may be cancelled if any information is found to be false.
I fully understand that this registration does not guarantee admission and the registration fee is
not refundable.
I also understand that even if my ward is admitted to class Pre-school (LKG) BALJYOTI, it does
not in any way guarantee automatic promotion to class Pre-Primary (UKG) and that I will have to
seek fresh admission for my ward to Pre-Primary through a process of admission as per admission
criteria applicable at that time.

Signature
Please Note:
1. Enclose only self-attested copies of the documents with this registration form. Originals will be
checked at the time of admission.
2. Incomplete forms will be rejected.

Date:
Place: