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Post graduation

OR Professional

Degree

Graduation

OR

Equivalent

Sr. Secondary

School Examination10+2 OR Equivalent

Secondary Schoolexamination

10th

OR Equivalent

Delhi Public School, Bangalore - NorthSurvey No. 35/A, Sathanur Village, Jala Hobli, Bangalore-562149 Karnataka, India

Tel: 28478041/42, Fax: 28478844 north@dpsbangalore.net / www.dpsbangalore.net

Please affixPassport

sizephotographofstudent

REGISTRATION FORMIssue of Registration Form Does Not Ensure Admission General Instructions1. Use only Black ball Pen to fill the form

2. Do not enter registration number yourself3. Use the codes given overleaf to fill locality code/ occupation code

For office use onlyRegistration No.____________ Receipt No.__________

Lyceum NoDate :______________

Name of the child (applicant) Male / Female(IN BLOCK LETTERS)

Date of Birth (dd/mm/yyyy):

(TICK)

(in words)

Class to which Admission is sought Age as on 30th June 2011

Nationality Mother tongue

Religion Please Tick ( ) SC/ ST/ OBC / Others: [Please Specify]

Blood group _______Second language (for UKG-X) ______________Third language (for V X )__________________

Whether School Conveyance required : Please Tick ( ) Yes No

Residential Address :Please give complete postal address

Pin Code : LocalityCode:(See overleaf)

Distancefromschool(inKms) PreferredPhoneNumberforSchoolSMS (only one) _____________________________

Sibling (DPS) Yes No Sibling Name ______________________________________________________

(only of real brothers/sisters)

If yes, give details Class-Section Admission NoChild with special needs:

Details of Parents

School Alumni (DPS)

Yes No Specify _______________________________________________

Yes No School Staff (DPS) Yes No

Educational Qualification(Tick highest qualification only)(Please specify)

Father

Mother

FATHER MOTHER

Name :

Occupation :

Occupation Code :

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FATHER (If applicable) MOTHER (If applicable)

Organisation Name :

Organisation Address :

Phone No :

Mobile No :

E-mail in block letters only

Are you aSingle Parent

If applicable specify

If child is sponsored(Name of sponsoring agency) ___________________________________________________________________________

Permanent Address of Agency _

D E C L A R A T I O N

I|We hereby certify that the above information provided by me/us is correct and I/we understand that if theinformation is found to be incorrect or false, the ward shall be automatically debarred from selection/admissionprocess 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 schooland I/we will abide by the decision taken by the school authorities.

Date :Name Signature

Father :

Mother :

Previous School's information (not applicable for nursery):

Submitted Transfer Certificate : (Please )Yes No

Admission In charge Principal / Vice Principal

The school provides transport facilities but offers no guarantee that a seat in the school bus will be available whenthe buses are full to capacity / do not ply in the area of your residence. It will be the responsibility of the parents /

guardians to drop / collect the child from the specified bus stop.

The child should be 3 + years of age as on 30 the June 2011 for NurseryThe registration made herein does in no way entitle the candidate to be admitted to the school.Incomplete / Invalid forms will be rejected.

Please attach the following :a) Photocopy of Birth Certificate

issued by Muncipal Corporation.b) 4 Latest passport size colour photographs.

Code Occupation

ADV Advocate HTL Hotel Locality DistanceAWS Airways CIV Civil Services Code From SchoolARC Architect

DEF Army / Navy / Air Force -

Defence Services

BNK Bank Employee

BUS Business(specify)

CAC Charted Accountant

DOC Doctor

EDU Educationist

EMB Embassy Employee

FIN Financial Organisation Employee

INT International Organisation

NWS Journalist/AIR/Print Media

MER Merchant Navy

OTH Others

PVT Private Service Employee

PUB Public Sector Employee

RWS Railway Employee

SCT Scientist

MIS None of the above

GOVT Government Employee

* Short listed candidateswill be intimated via SMS

O 0-3 Km

A Above 3 Km up to 5 Km

B Above 5 Km up to 10 Km

C Above 10 Km up to 20 Km

D Above 20 Km

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Brochure Fees:

Applicant within India:

A sum of Rs. 600/- (non-refundable) to be paid by bank draft drawn in favour of DPS Bangalore North.

(Name of the student, Registration No., & Fathers name to be clearly stated at the back of the bank draft.)

Applicant outside India:

A sum of 75 USD (non-refundable) to be paid by bank draft drawn in favour of DPS Bangalore North.

(Name of the student, Registration No., & Fathers name to be clearly stated at the back of the bank draft.)

______________________________OFFICE USE ONLY________________________________

Demand Draft Received from________________________________________________________

D.D Amt ___________ Date____/_____/______ Bank___________________________________

Authorized Signature