Admission  Form
 Affiliation No -330379,  School Code- 50311
   Katra ,Gudri Rai Chowk, Near Satya Narayan Mandir
 Chapra  Pin -841301(Bihar)
Form No - 
Admission No- Admission Date- Admission Class -
Student Details -
Student Name First Name - Middle Name Last Name -
Date Of  Birth  -
Father's Name  
Qualification Profession
Mother's name  
Qualification Profession
Residential Address -
Pin Code -
Contact - Phone No- Mobile No -
E- mail-
Permanent  Address  -
Pin Code -  
Contact - Phone No- Mobile No -
E- mail-
Sex Male - Female -
Single Girl Child- EWS- SDS-
Religion- Caste-
Day Scholor Boarder
Family Income Per Annum  
Health Status-
Height Blood Group Weight
Vision - Teeth Oral Hygiene Specific Ailment
Physical Challenge (if any) -
Attitudes Hobbies 
Field Of Interest
Sports -
Painting - Yes        No-  
Music Vocal -  Instrumental  
Name Of Instrument -
For Emergency Only -
Landline No- Person To Contact - Mobile No -
Relation With Ward - E-mail Id-
Declaration By Parent-
I / We Hereby certify that The Above Information provided by Me/us is correct and I/we Understand that the information is found to be incorrect or false, the ward shall be automatically Debarred From selection /admission without any correspondence in this regard  i /we also understand that the application/registration/shortlisting does not guarantee admission to my ward. I /we accept the process of admission undertaken by the school and I /will abide by the decision taken by the school authorities.
Signature Of Mother                                                                                 Signature Of Father            
Date                                                                                                                       Date    
Place                                                                                                                      Place
Admission Granted                                                                                                                                    Not Granted
General Instruction-
Use Only Blue /Black Ball Pen to Fill The Form
Use Appropriate Tick Mark  in Relevent Box.
Note - Submit the downloaded form at school office along with the fees of prospectus also.