NAZARETH SCHOOL

(Affiliated to Central Board of Secondary Education - New Delhi)

CBSE Affiliation No:830134

BALMATTA, MANGALORE-575002

TEL: 0824-2950268, 9902401537

E-mail: [email protected],

General Instructions:

1) To be filled and signed only by Parents. Name and DOB entered in this form will be treated as final and no changes will be accepted in the future.

Student

Basic Details

Full Name *

Gender *

Date Of Birth *

Child's Aadhar Card Number * (Note: If you do not have an Aadhar card number, enter a 12-digit temporary number. Later, submit the actual Aadhar card number to the office.)

Place of Birth

Village/Town *

Taluk *

District *

State *

Language, Nationality & Religion

Blood Group *

Mother Tongue *

Nationality *

Religion *

Other *

Caste Category *

Caste Name *

Grade of Admission *

Family

Father Details

Full Name *

Employed/Self Employed*

Employed Self Employed

Occupation

Designation

Organisation/Office Name

Office Ph. No.

Annual Income (In Rupees)

Mobile No. *

Aadhaar Card No. *

Mother Details

Full Name *

Employed/Self Employed/House Wife*

Employed Self Employed House Wife

Occupation

Designation

Organisation/Office Name

Office Ph. No.

Annual Income (In Rupees)

Mobile No. *

Aadhaar Card No. *

Communication Details

Residential Address *

Pincode *

Phone No. Residence *

Sibling Details (If applicable)

Do you have siblings in our school studying? *

Yes No

Guardian Details

Staying with? *

Parents Guardians

Full Name *

Realationship with the child *

Mobile Number *

Email *

Residential Address *

Other Details

Single Parent (If applicable)

Father Mother

In case Parents are seperated, custody of the child is with (If applicable)

Father Mother

Academic Details

Grade & Language for Admission

Second Language (I and VII) : Kannada

Third Language (I and VII) : Hindi

Second Language (IX and X) *

Academic Record (Hard copy should be submitted to the office)

Do You have the details of prevous schooling and grades or marks obtained in last exam ?

Health History

Weight (in kgs) *

Height (in cms) *

Has your child ever had any of the following illness if so,when?

Name	Yes/No	Date
Chickenpox	Yes No
Measles	Yes No
German Measle	Yes No
Mumps	Yes No
Diptheria	Yes No
Rheumatic Fever	Yes No
Heart Disease	Yes No
Poliomyelitis	Yes No
Diabetes Mellitus	Yes No
Epilepsy	Yes No
Tuberculosis	Yes No
Whooping Cough	Yes No
Ear Condition	Yes No
Operation	Yes No
Asthama	Yes No
Allergies	Yes No
Serious injury	Yes No
Others	Yes No

Has your child had any of the following Protective measures if so, when?

Name	Yes/No	Date
BCG Vaccination	Yes No
Polio	Yes No
MMR	Yes No
Mumps	Yes No
Tetanus	Yes No
Hepatitis_A and B	Yes No
Whooping Cough	Yes No
Others	Yes No

Date of last physical Check up (If there is anything concerning the health of your child, Which the school should know, Please attach an additional sheet with this form(Include such things as eyesight,allergies and any specific disability.))

Documents

Student Photo (png,jpeg,jpg)

Birth Certificate (png,jpeg,jpg)

Copy of Passport (Foreign Nationals)

Transfer Certicate (png,jpeg,jpg)

School Performance Report (png,jpeg,jpg)

Family photograph (png,jpeg,jpg)

Caste Certicate (png,jpeg,jpg)

Aadhar Card (png,jpeg,jpg)

Finish

Declaration

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.

Secondary School Application for Admission

NAZARETH SCHOOL

General Instructions:

Student

Basic Details

Place of Birth

Language, Nationality & Religion

Family

Father Details

Mother Details

Communication Details

Sibling Details (If applicable)

Guardian Details

Other Details

Academic Details

Grade & Language for Admission

Health History

Has your child ever had any of the following illness if so,when?

Has your child had any of the following Protective measures if so, when?

Documents

Finish

Declaration