Application Form

APPLICATION FORM

Note - • Fill the form using a blue/black ball point pen in block letters. • Make sure all necessary and valid documents are attached along with the form • Please indicate the category to which you are applying with a tick mark in the relevant column.

Affix the latest Bowenpally Alwal Boduppal Gandipet Saroornagar Tivoli Passport size colour photograph S.No. ______Alumni of the student Admission No. ______Sibling Admitted in ______class General

Date of issue of application : dd/mm/yyyy Date of submission : dd/mm/yyyy

(Admission process should be completed within one week of issue of application)

Section 1. Personal Details

1.1 Name of the student first name last name (no change will be made later)

1.2 Date of birth dd/mm/yyyy 1.3 Place of birth place of birth (no change will be made later)

1.4 Gender Male Female 1.5 Mother Tongue 1.6 Blood Group

1.7 Identification Marks 1. 2.

1.8 Nationality 1.9 Religion

1.10 Caste SC ST BC - A/B/C/D/E OBC (as per caste certificate) Others 1.11 AadhaarSAMPLE No. with date of birth & Name in full ONLY

Section 2. Admission Details

2.1 Class in which admission is sought

2.2 For Class XI & XII Science MPC IP/PE BiPC IP/PE Others Commerce MEC AEC IP/PE

2.3 Presently studying in Class School

2.4 Board CBSE ICSE SSC 2.5 Place

2.6 Language options (a) II Language Hindi Telugu Sanskrit (Class VIII & above) (b) III Language Hindi Telugu Sanskrit (Class V to VIII)

2.7 Does your child have any known medical conditions? If yes please provide details/relevant documents

a. b.

www.pallavimodelschools.org | 1800 212 111111 1 Section 3. Contact Details

3.1 Details of parents

Affix the latest Affix the latest Passport size Passport size colour photograph colour photograph of the student’s of the student’s father mother

FATHER MOTHER

3.2 Name father’s name with expanded initial mother’s name with expanded initial (details once given cannot be changed)

3.3 Educational Qualifications

3.4 Profession

3.5 Designation

3.6 Name of the organization

3.7 Annual Income

3.8 Office Address

3.9 Residential Address

3.91 Mobile No, / Landline No.

3.92 EmergencySAMPLE Contact No. ONLY SAMPLE ONLY

3.93 E-mail ID

3.94 Details of sibling(s) studying in this School : (if applicable)

S.No Full Name Class & Section Admission No.

3.95 Guardian’s Name (if applicable)

Address

Mobile No.

3.96 Areas in which the parent can contribute as a stake holder in the student’s development

Cultural Medical Media Professional Sports

www.pallavimodelschools.org | 1800 212 111111 2 DECLARATION

• I, the undersigned, hereby declare that I am the father/mother/legal guardian of Master / Miss applicant - student

• I promise to abide by the school rules and regulations and abide by any change of school timing, programmes, planning etc.,

• Registration fee is non refundable. Obtaining application form/applying online does not imply admission. Admission is subject to availability of seats. In case of withdrawal of admission, I am aware that I am not entitled for refund of any fee deposited, irrespective of when my ward was admitted. Only caution deposited is refundable. In case of withdrawal in the middle of the Academic Year, I will be paying the tution & transport fee also for that year.

• One term advance intimation to be given in writing for withdrawing transport facility/admission. In case of withdrawal of admission of my ward, the term fee and transport fee availed for that term will be borne by me. Transport fee or Term fee are neither refundable nor adjustable.

• In case of any damage/loss caused to the school property by my ward, the damage charges will be paid to the school to the extent of the cost applicable.

• Expensive articles/jewellery shall not be worn by students. School is not responsible for its loss.

• That the school reserves the right to expel my ward anytime, including the final external examination period for indulging in any act of gross misconduct/indiscipline. Also, that any action taken by the school on any matter concerning my ward will be final and binding on me.

• Pallavi Model School plies school buses on the fixed routes with limited stops. It will not be obligatory on the part of the school authorities to make new bus stops. It will be the sole responsibility of us to escort the pupil to and fro from the respective bus stop. I am aware that the routes and stops are subject to changes. I am aware that no request for pick up /drop of my ward other than the designated point and no request for travelling other than the designated route is accepted. I will respect the discretionary authority of the school to alter the bus route/bus stops as and when the need arises.

• I do understand that programming and philosophy of education at PMS is to emphasize overall development of the child along with sports, excursions and other co-curricular activities besides academics. I shall permit my SAMPLE ONLY ward to SAMPLEparticipate and fully cooperate with the school in this regard. ONLY • I have no objection in receiving SMS from School. I give consent to use photographs of my ward in the magazines, flyers, prospectus, advertisements and other publications of the organization.

• I abide by the given fee structure. I am aware that there is a different fee structure within the class and also aware that it is subject to revision every year.

• I assure that the information provided in this application form is correct to the best of my knowledge. I will not request for correction/changes in name of my ward/ in our (parents) names and date of birth of my ward. I promise to abide by the school rules and regulations and abide by any change of school timing, programmes, planning, etc.

Having read carefully the above details, I hereby accept and endorse the above declarations.

Signature of Father Signature of Mother Signature of Guardian

Date :

www.pallavimodelschools.org | 1800 212 111111 3 Undertaking

I do hereby agree and declare that

• My ward……………………………………… studying in class …………… of Pallavi Model School may be permitted to take part in Inter School Sports or Co-curricular competition /any camp / course / adventure / training / treks / swimming / NCC / mountaineering / rock climbing / hiking / skating / cycling / horse riding / yoga/ field trips/Excursions/or any adventure activities which involve risk, organized by the school for the students’ practice / show / competition at all levels. I undertake and agree to hold the school and its staff indemnified against all such claims that may arise out of any loss or fatal injury to the property or person which my ward may suffer while or in consequence of participation in any such activity.

• I understand that the school shall take all possible efforts to ensure the safety of my child in the school / school bus. Inspite of their efforts, in the unfortunate event of any injury/harm/accident/loss of life during the course of stay of my child in school /school bus, I shall not hold the school or the authorities responsible for the same.

• I understand that the school cafeteria is an optional facility and is outsourced to an agent. Though school shall take all precautions of food safety and hygiene, however in case of any health ailments arising due to thisSAMPLE facility, I shall not hold the school or the authorities responsible ONLY for the same. SAMPLE ONLY

Father’s Name : Father’s Signature :

Mother’s Name : Mother’s Signature :

Address :

Date : Place :

www.pallavimodelschools.org | 1800 212 111111 4 Eligibility Criteria

1. The child should be 2 ½ years of age as on 31st March for Nursery. 2. The child should be 3 ½ years of age as on 31st March for LKG. 3. The child should be 4 ½ years of age as on 31st March for UKG. 4. The child should be 5 ½ years of age as on 31st March for Class I.

Mandatory documents to be submitted during admission

a) Birth Certificate (Original) f) Residential Proof

b) Transfer Certificate (Original) g) IX Class Registration details c) Caste Certificate h) Certificate of any special achievement d) Report Card of previous class i) Others (if any) ......

e) Passport size photographs x 5 j) Vaccination card/Evidence of vaccination k) Aadhaar Card

For office use only

Admission No. : ......

Admitted to Class : ......

Admitted to Stream (for Class XI / XII) : ......

Date of Confirmation : ......

Date of Admission : ......

Principal’s Remarks Fee Reciept No. & Date : ......

Amount Paid : ...... SAMPLE ONLY SAMPLEActivity Fee ONLY : ...... Caution Deposit : ......

Term Fee : ......

Others : ......

ADMITTED/REJECTED

Signature Manager / Accounts Assistant

www.pallavimodelschools.org | 1800 212 111111 5 PALLAVIOUR BRANCHES MODEL SCHOOL | | | | | | | www.pallavimodelschools.org | 1800 212 111111 PALLAVI MODEL SCHOOL PALLAVI MODEL SCHOOL PALLAVI MODEL SCHOOL BOWENPALLY SAMPLEALWAL ONLYBODUPPAL SAMPLE ONLY +91 7032 9932 99 +91 9396 956 471 +91 7660 0024 69 [email protected] [email protected] [email protected] Nursery to XII Nursery to XII Nursery to X

PALLAVI INTERNATIONAL SCHOOL PALLAVI AWARE SCHOOL AKSHARA VAAGDEVI INTERNATIONAL SCHOOL GANDIPET SAROORNAGAR TIVOLI +91 70933 311 70 +91 9100 1888 22 +91 9573 4697 59 [email protected] [email protected] [email protected] Nursery to VII Nursery to VIII Nursery to X