Pakshalika High - path to excellence

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Student Admission Form

Name*

Nick Name*

Nationality*

Home Address*

Date of Birth*

Gender

Blood Group*

Contact No. (Residence)*

Email*

Programs*

Days Per Week*

Timings*

Parental Details

Father's Name

Occupation*

Designation

Mobile No.*

Email ID

Mother's Name

Occupation*

Designation

Mobile No.*

Email ID

Emergency Contact Person

Name*

Relation*

Contact No.*

Mode of Transport*

Pick Up Time*

Pick Up From*

Medical Details

Restrictions for Play - Outdoors*

Restrictions for Play - Indoors*

Allergies*

Fears*

Diaper changes/Ointment/Powder*

Physician to call (if needed)*

Physician Address*

Physician Contact No.*

Feeding Pattern

Food Likes*

Food Dislikes*

Feeding Instructions (if infant)*

Sleep Pattern

Does the child nap?*

Approx. Time*

Approx. Duration*

Is child toilet trained?*

Other information to help in caring for the child*

Authorization for Emergency Medical Care and Transportation

I authorize the staff representing Sswings to give consent for any necessary emergency medical treatment for my child and I will reimburse all the medical expenses incurred.

My child has my permission to be transported by Sswings on field trips in a bus or car by school staff or a volunteer parent. I indemnify Sswings and its representative against any claims and demands.

I promise to abide by all rules and regulations of the school.