Student Profile

Form No.		Phone : 0161-2457393, 2464444 Fax : 0161-2463480 E-mail : info@bcmeducation.org website : www.bcmeducation.org


	B.C.M. Arya Model Sr. Sec. School
	Shastri Nagar, LUDHIANA
	[Affiliated to Central Board of Secondary Education, New Delhi]
	APPLICATION FORM FOR REGISTRATION
Class Registration No. (For office use only) ___________

CHILD INFORMATION DOSSIER

Applicant Name

DOB

Gender

Girl

Father's Name

Mr.

Mother Name

Mrs.

Address

PIN code

Mobile No.

Other Contact

E-Mail ID

2. Monthly Income :

Rs./-

3. Sibling:
(Real brother/sister only)

Sibling's Name (Studying at BCM):

4. School Alumni:

Year of Passing - Class

FATHER

-NA-

MOTHER

-NA-

5. Parents Qualification:
(Highest Qualification only)

FATHER :

MOTHER :

6. Parents Occupation:

FATHER

Occupation:

Designation:

Name & Address:
of organisation

MOTHER

Occupation:

Designation:

Name & Address:
of organisation

7. Single Parent:
(Tick one, only if applicable)

8. Medical History:

1. Height : Cms

2. Weight : Kgs

3. Blood Group :

4. The child has been innoculated against:

5. Does your child suffer from bed wetting? -

6. Does your child have any identified allergies? -

7. Please give history of any serious illness of the child in the past

9. Child with Special Needs:
(Enclose authenticated documents)

10. Give the order of preference (1 to 6) for the following criteria you would look for in a school?

11. Area of Interest where parental contribution could enrich the school

12. Locality:

Distance from School: Kms.

DECLARATION
I/We hereby certify that the above information provided by me/us is correct and I/We understand that if the information is found to be incorrect or false, the ward shall automatically be barred from selection/admission process without any correspondence in this regard. I/We also understand that the application/registration/short listing does not guarntee admission to my ward. I/We accept the process of admission undertaken by the school and I/We abide the decision taken by the school authorities. Date : Mother Father / Guardian