Reg. Form No. : ..

Application No. : Date : ... Signature: .

DELHI PUBLIC SCHOOL

SAIL TOWNSHIP, P.O. DHURWA, RANCHI 834 004.
Phone : 0651-6452405, 6452406, 2441176, Fax 0651-2440707, Website : www.dpsranchi.com

Affiliated to CBSE, New Delhi, Affiliation No. 3430053 Managed by THE DELHI PUBLIC SCHOOL SOCIETY, NEW DELHI (Registered Under the Societys Registration Act, 1860)

REGISTRATION FORM
ISSUE OF REGISTRATION FORM DOES NOT ENSURE ADMISSION PAY RECEIPT NO. . Please affix recent Stamp size Photograph of Applicant REGISTRATION FEE NON-REFUNDABLE CLASS .. STATUS : ..

[Tick the appropriate box] 1. Name of the applicant: (BLOCK LETTERS)

2.

Date of Birth: (Enclose attested Xerox copy of Municipal Certificate) D D M M Y Y Y Y

3. 4. 5.

Gender

Boy

Girl No Yes No

Single Girl (Only Child) (Enclose proof) Yes Sibling (Own brother/ sister only) whether sibling studying in DPS Ranchi (Enclose bonafide certificate issued by the school)

If yes, then give details Name: ...... Class/ Sec ... Adm. No. ..

6. 7.

Nationality of the candidate..... Religion.. School Alumni (A) Father (Enclose proof) (B) Mother (Enclose proof) Yes Yes Yes ST [If Yes, year of passing] [If Yes, year of passing] No SC OBC No No

8. 9.

Child with Special Needs Category : GEN.

(Enclose Medical certificate) (Enclose Caste certificate) 10. 11. 12. Fathers Name (BLOCK LETTERS) : .... Mothers Name (BLOCK LETTERS): .. Residential Address : (Enclose proof of residence) .. .. Pin Code.. Permanent Address : ... ... ...

Contact Phone No (s)....Mob. .....

13. 14.

Whether transport required:

Yes

(If Yes, Bus Stop : ........)

No

Educational qualification (Tick highest qualification only) Post Graduate OR professional degree Father Mother Graduation OR Equivalent Sr. Secondary School Exam. 10+2 OR Equivalent Secondary School Exam. th 10 OR Equivalent

15.

Parents Occupation Occupation Father Mother

Designation / Pl. No.

Name of the Organization

16.

Whether belong to BPL category : (If yes, enclose certificate issued by competent authority)

Yes

No

INSTRUCTIONS : 1. 2. 3. Transfer Certificate in original will be required after admission is granted along with one copy of recent stamp sized photograph of the student. Once admission is approved the student will not be allowed to withdraw during the academic session without prior permission of the principal. The school provides transport facilities, but this offer is not any way bound to offer a seat in the bus which is completely based on availability of seats and plying of the bus in the particular route. It will be the responsibility of the parents / guardians to drop / pickup the child from the specified bus stop. Students will not be allowed to discontinue transport facility during the academic session.

CERTIFICATE OF UNDERTAKING : 1. I fully understand, that the school, on accepting the registration of my ward is not in any way bound to grant admission which is purely based on the availability of seats. I also understand that the decision of the Principal regarding admission will be final and binding. 2. In the event of my ward getting selected for admission, I shall have no objection to the school Medical Officer giving inoculation against Typhoid A, B and Cholera to my child. 3. In case of withdrawal of my ward I agree that admission fee and other fees will not be refunded except the caution money which will be refunded only after 3 months from the date of issue of TC. 4. I also take the responsibility that my ward will attend school regularly and maintain 75% attendance as per CBSE rules. 5. I agree to abide by the rules and regulations of the institution. If any information of declaration furnished by me proves to be false, my wards candidature may be cancelled at any stage.

Please affix recent Passport size Photograph of Mother

Please affix recent Passport size Photograph of Father

Signature of Mother : ..... Date : ... CHECKED BY

Signature of Father : ..... Date : .. SIGNATURE OF PRINCIPAL