st. pius x international school-spxisspxis.org/pdfs/admission_form.pdf · 1 st. pius x...
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ST. PIUS X INTERNATIONAL SCHOOL-SPXIS Nahur, Mulund West, Mumbai – 400 080.
ADMISSION FORM
(20__-20__) Instructions:
Please read the application form carefully before filling it.
Admission granted on the basis of incorrect information will be null and void.
Please fill the application form in BLOCK letters
Please note that an incomplete Application Form will be rejected.
1. CHILD’S PERSONAL INFORMATION
Child’s Name: _______________________________________________________ (Surname) (Name) (Father’s Name) (Mother’s name)
Date of Birth: __________________
Place of Birth: ______________________________ Nationality: ______________
(Town & State)
Religion: ______________________________ Blood Group: ________________
Language Spoken at Home: ____________________________________________
Residential Address: _________________________________________________
___________________________________________________________________
PIN CODE __________________ Residential Contact No. ____________________
Please tick which is applicable: 0-1 km 1-3 km 3-5km 5-8km
above 8 km
PassportPhoto ofthe Child
Level Enrolling for:
International Early Year Curriculum – Nursery (3 years completed as on 30th September)
International Early Year Curriculum – Jr. K.G. (4 years completed as on 30th September)
International Early Year Curriculum – Sr. K.G. (5 years completed as on 30th September)
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2. FATHER’S PERSONAL INFORMATION
Father’s Name: _____________________________________________________
Age: __________________ Mobile No.___________________________________
Email ID____________________________________________________________
Educational Details:
NAME OF THE INSTITUTION PLACE OF INSTITUTION
School
College
Professional
School Alumni (Past Pupil): If yes, year of passing _________________________
Are you closely associated with the school? YES No
If yes, in what way? __________________________________________________
Transferable Employees: Defence Income Tax Customs Police
(Govt. /Pvt. Sector) Sportsman Teacher Doctors Others
Name of the Organization:______________________ ______________________
Office Contact No.: __________________________________________________
Annual Income (Rs.):_________________________________________________
3. MOTHER’S PERSONAL INFORMATION
Mother’s Name: _____________________________________________________
Age: ________________ Mobile No._____________________________________
Email ID____________________________________________________________
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Educational Details:
NAME OF THE INSTITUTION PLACE OF INSTITUTION
School
College
Professional
Transferable Employees: Defence Income Tax Customs Police
(Govt. /Pvt. Sector) Sportsman Teacher Doctors Others
Name of the Organization: ____________________________________________
Office Contact No.: ____________________Annual Income (Rs.) _____________
Emergency Contact number for communication: __________________________
4. SIBLING’S INFORMATION
Siblings studying in St. Pius X (State) School: Yes No
(Real brother/sister only). If yes,
Class __________ Div. _____________ G.R. No. of Sibling ________________
5. PARENTAL ASSISTANCE:
We are keen to use talent and resources that are available in the school
community and that can enrich our school programmes.
Please indicate if you may be able to make any special contribution to
St. Pius International School-SPXIS such as:
Teaching of Music Dance Coaching Sports Other
If any other competence (please mention) _______________________________
1. Name of the Sibling ______________________________________ studying in
Class __________ Div. _____________ G.R. No. of Sibling ________________
2. Name of the Sibling ______________________________________ studying in
Mother’s Signature: __________________
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6. DECLARATION:
We hereby declare that the information provided in this form is true to the best of our
knowledge and belief. We understand that if, at any stage it is found that we do not
satisfy the admission criteria or the information furnished by us is incorrect, our
application may be disqualified.
We have read and understood that school rules and regulations with regard to
admissions and agree to abide by them. We understand that the decision of the school
with regard to our child’s admission will be final and binding upon us.
Father’s Signature: ___________________ Submission Date: _____________________
Guardian’s Signature: _________________
RULES FOR ADMISSION
At no time and under any circumstances will, any request for a change of thedate of birth is entertained.
All documents once submitted become the property of the school andcannot be returned.
The admission will be done by an “Admission Panel” and its decision will befinal.
Admission will be given as per availability of seats
SUBMITTED PHOTOCOPIES OF:
Birth Certificate Family Photograph
Baptism Certificate (if any) Caste Certificate (if any) Aadhar Card
Ration Card
Income CertificatePassport size Photograph
Submitted by: ______________________________________________________
(Name and Signature of the Parent)
Verified by: ______________________________________________________
(Name and Signature of the Teacher)
SUBMIT BY EMAIL