Student's

Photograph
Application No. : ___________________________

Admission Form
All elds are mandatory

Date of Admission:______/______/_______/ (dd/mm/yy)

Admission sought in : Play Group Nursery Junior KG Senior KG

Time Slot (Batch) preferred______________________________________________________

Pa iculars of the Child

First Name : ________________________________________ Surname : _________________________________

Name used at home : _____________________________________________

Sex : Male Female

Nationality: _____________________________________________

Date of Bi h _______/_______/_______ (dd/mm/yy)

Age : Years:_________ Months:_________ Days:________

Language(s) Spoken at Home: English Hindi Others___________________

Residential Address:

______________________________________________________________________________________________

______________________________________________________________________________________________

Landmark: ____________________________________________________________________________________

Town / City: ___________________________________________________________________________________

State: ______________________________________________ PIN Code: _________________________________

 Pa iculars of Parents / Guardian
I) Father / Guardian

Name: ________________________________________________________________________________________

Educational Quali cation: Undergraduate Graduate Postgraduate

Occupation: Service Business Others (Please Specify) __________________________

Name of the Organisation: ______________________________________________________________________

Tel. No. : [Res.] _______________________ [O .] _______________________ [Mob.]_______________________

E-mail Address: _______________________________________________________________________________

II) Mother

Name: ________________________________________________________________________________________

Educational Quali cation: Undergraduate Graduate Postgraduate

Occupation: Homemaker Service Business Others (Please Specify) _________________

Name of the Organisation: ______________________________________________________________________

Tel. No. : [Res.] _______________________ [O .] _______________________ [Mob.]_______________________

E-mail Address: _______________________________________________________________________________

For us to contact you through SMS, Call or E-mail, please tick one of the boxes, to whom the SMS / Call / Email

should be sent Father / Guardian Mother

Family Details
I) Ma ial Status of Parents

Married Separated Divorced

If separated / divorced, child is under the custody of

Mother Father Others (Please Specify) __________________________________________

More about your Child

Previous Schooling: Yes No

If yes, please specify: __________________________________________________________________________

Is your child toilet-trained? Yes No

How many siblings does the child have ?

Brothers (mention age) 1.______________________ 2.______________________ 3.______________________

Sisters (mention age) 1.______________________ 2.______________________ 3.______________________

 Medical Record
Blood Group :______________________

Speci c Ailments su ered in the past:_____________________________________________________________

Surgery undergone (if any):______________________________________________________________________

Allergy (if any): _________________________________________________________________________________

Are all the relevant vaccinations taken ? Yes No

Does your child su er from any phobias? Yes No

If yes, please specify:___________________________________________________________________________

Is the child presently on any regular medication? Yes No

If yes, please specify:___________________________________________________________________________

Is your child physically t to a end regular classes with no requirement for medical care / precautions?

Yes No

Any special instructions:

______________________________________________________________________________________________

______________________________________________________________________________________________

In case of your unavailability during an emergency, alternate contact person:

Name (other than parent):_______________________________________________________________________

Mob. :_________________________________________________________________________________________

Declaration of Parent / Guardian

I declare that the information given is correct and complete and I have not withheld any information.

I agree to entrust my child under the care of the sta at London Kids Pre-School. I shall not hold London Kids
Pre-School responsible for any unavoidable mishap or accident.

I am aware that the fees once paid is non-transferable and non-refundable under any circumstances.

By signing this form, I agree to receive promotional SMS and communication with respect to my London Kids
Centre.

I have read through the London Kids Pre-School policies and am in agreement with the said policies.

Parent's Name : __________________________________

Signature : __________________________________

Date : __________________________________
Terms & Conditions:
! Acceptance of the application form does not guarantee admission.

! Con rmation of the admission is subject to payment of the admission fee.

! The admission is conditional and may be withdrawn by the Pre-School if I / We are found to be in breach
of any of the terms of our declaration in this form.

Documents required for the Admission:

¨ Complete Application Form
¨ Photocopy of the Bi h Ce i cate
¨ 2 Passpo Size Photos of the Child
¨ Proof of Residence
¨ 2 Passpo Size Photos of Parents
¨ Photocopy of Vaccination Ce i cate / Record

For O ce Use Only:

Fee Details
(To be lled in by o ce sta )

Registration Fee : `_______________________

Admission Fee : `_______________________

Tuition Fees : Term 1 : `_______________________

Term 2 : `_______________________

Term 3 : `_______________________

Student Kit Charges : `_______________________

Caution Fee : `_______________________

Activity Fee : `_______________________

Other (Specify) : `_______________________

`_______________________

`_______________________

Total Fees : `_______________________

Centre Code & Address:

__________________________ __________________

Signature of the Centre Head Date