ENTRAR- REGISTRATION FORM

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Name of the child (Nursery To 1 as per Birth certificate and II To IX as per TC credentials)
Red Border Fields Are Mandatory

APPLICATION FORM

Academic year*

This field is required.

Age as on 1st June 2021:

This field is required.

Whether School Conveyance Required

Temporary Address

This field is required.

Permanent Address

As above

This field is required.

Mobile No

This field is required.

Sibling And Alumni

Sibling's studying in NAGARJUNA VIDYANIKETAN:
If yes,give details(only of biological/own brothers/sisters)

This field is required.

Father's details

As per child's date of birth certificate This field is required.

This field is required.

Mother's details

As per child's date of birth certificate This field is required.

This field is required.

Guardian's details

This field is required.

Medical Information

This field is required.

Medication : Please checked in the blocks if you give permission for state of the Center to administer the follwing treatment to your child.

Type of medication	Use	Permission to administer
Germolene	Cuts or scrapes
Buru shield	Burus
Mercurochrome or Gentain violet	Cuts or open wounds

MEDICAL INFORMATION CONTINUED

Has the child sunered from any of the following illnesses?

Allergies:

Reaction to allergies:

Infections diseases child has already suffered

Serious illnesses/ special needs/ psychological or behavioural disorders etc.

Any operections

Chronic medication child is on :

Please specify any professionals who have been involved, or are still invovled in your child's development (E.g. A speech Therapist, OT or Education Psychologist).
Name and Phone number :

Photograph

Student's Photo :
(.jpg only and less than 1 MB)
Kindly submit 2 passport size photographs of the student at the time of admission This field is required. Only JPG formats are allowed . Please select file less than 1 MB. .

Father's Photo :
(.jpg only and less than 1 MB) This field is required. Only JPG formats are allowed . Please select file less than 1 MB. .

Mother's Photo:
(.jpg only and less than 1 MB) This field is required. Only JPG formats are allowed . Please select file less than 1 MB. .

Birth certificate :
(.jpg only) This field is required. Only JPG formats are allowed . Please select file less than 3 MB. .

DECLARATION :

I / We confirm that information. I / We have providedls correct, I / We further agree to inform the school promptly, in writing, of any subsequent changes. I / We agree to meet all financial responsibilities promptly. I / We understand that any incorrect information given by me/us will render the application invalid and consequently, the admission granted will be cancelled.

Asthma	Enteric Fever	Measles	Scarlet Fever
Chicken Pox	German Measles	Mumps	Tick Bite Fever
Diabetes	Hepatitis	Polio	Typhoid Fever
Diphtheria	Malarai	Rheumatic Fever	Whooping Cough