Pakshalika High - path to excellence

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Admission Form for Higher Classes

Student Details

Name of the Child*

Gender*

Date of Birth*

Age on April 1*

Class in which admission is sought*

Residence Address*

PIN Code*

Contact Number*

Permanent Address (If different from residence)

Permanent PIN Code

Name & Address of Present School (if applicable)

Special Needs (if any)

Parents/Guardians Details

Mother's Full Name*

Educational Qualifications

Occupation

Designation

Address

Residence Address

Office Address

Email ID

Telephone (Residence)

Mobile No.*

Father's Full Name*

Educational Qualifications

Occupation

Designation

Address

Residence Address

Office Address

Email ID

Telephone (Residence)

Mobile No.*

Full Name of Guardian (if different from Parent)

Age

Relationship with Child

Educational Qualifications

Occupation

Designation

Address

Residence Address

Office Address

Email ID

Telephone (Residence)

Mobile No.

Siblings Details

Sibling 1 Name

Age

Gender

Name of School

Sibling 2 Name

Age

Gender

Name of School

Transport Service

Will school transport be required for your child?*

Yes

Distance of child's residence from school in KM*

Areas to contribute in school life

Please tick the appropriate boxes:

Cultural

Medical

Academics

Outdoor Activities

Sports

Any other (please specify)

Declaration

I/We hereby certify that the information provided in this Admission Form is complete and accurate. I/We understand, and agree, that any misrepresentation or omission of facts will justify a denial of admission, cancellation of admission, or expulsion of my/our child/ward.