ONLINE REGISTRATION FORM
(Session 2019-20)
Reach Us: 887 - 3002602
Please mail us at : info@srcspatna.com
(Submission of this form does NOT guarantee Admission)
Student Passport Size Photo.
(png/jpg) *
Father Passport Size Photo. (png/jpg)
Mother Passport Size Photo. (png/jpg)
PERSONAL DATA OF STUDENT (Yellow fields are Mandatory)
Candidate Name*
Admission Required for Class*
Date of Birth *
Age (as on 31st March)
Place of Birth of Student (City,District,State)
Caste * (In case of OBC/SC/ST cast certificate has to be furnished) Religion: Gender: Male Female
Aadhar Card* Mother Tongue
Languages Spoken at home Student Nationality
Father's Name Mother's Name
Stream Opted For Class XI
Science (PCM/PCB) Commerce
Sibling Details
S.No. Name of Sibling Age School/ College Class
1
2
RECORD OF PREVIOUS CLASSES ATTENDED
S.No. Name of School Location Class Year Board CBSE/ICSE/State Medium of Instruction % of Marks in last Class Passed Reason for leaving
From To From To
1
2
Status of Health (tick if any) attach relevant medical documents (for Special Care)
Differently Abled: Past Illness: Chronic Medical Problem:
Allergy: Others:
Emergency Contact Number: Emergency Contact Name: Relation:
Achievements In Academic/Sports/Co-Curricular Field
S.No. Field Year Event Details of Prizes/Award/Position
1
2
3
PARTICULARS OF FAMILY
Particular Aadhar Card Number Qualification Occupation Annual Income Contact No. Email ID
Father
Mother
Local Guardian (Relation with Child)
Local Address Permanent Address Local Guardian's Address
The following documents to be submitted at the time of admission, failing which the admission stands cancelled-
Photocopy of Birth Certificate Transfer Certificate in original
Photocopy of Address Proof (Ration card/ telephone bill/ gas connection/ electricity Bill) Photocopy of Aadhar Card
Photocopy of Last 2 years report card (for class 2 and upwards) Medical Report (for Special Care)
Mother's and Father's Photo ( 2 each ) In Case of OBC/SC/ST, relevant attested documents
Passport Size Photograph(No.of Copies 4)
Original TC and photocopy of Mark Sheet of previous class to be submitted within 10 days of beginning of the new academic session, for which the admission of your ward has been sought.
UNDERTAKING
a) The information furnished above is correct and complete to the best of our knowledge.
b) We understand that there are constraints of vacancy in each class and admission cannot be confirmed by mere registration.
c) We understand and agree that misrepresentation or omission of facts will justify the denial of admission, the cancellation of admission or expulsion from school.
d) We have read and hereby agree to the terms and conditions given in the form.
e) We shall abide by all the rules and regulations of the school laid by Management along with changes, if any, intimated to us time to time.
Payment Details
Registration Fee INR 1000
Total Fee INR 1000
In case of any difficulty in submitting the form, please call on helpline 8249196429 Powered by SchoolBellQ*