PALLAVI MODEL SCHOOL

1www.pallavimodelschools.org | 1800 212 111111

APPLICATION FORM

Section 1. Personal Details

Section 2. Admission Details

1.1 Name of the student

1.2 Date of birth 1.3 Place of birth

1.4 Gender 1.5 Mother Tongue 1.6 Blood Group

1.7 Identification Marks

1.8 Nationality 1.9 Religion

1.10 Caste

1.11 Aadhaar No. with date of birth & Name in full

2.1 Class in which admission is sought

2.2 For Class XI & XII

2.3 Presently studying in

2.4 Board 2.5 Place

2.6 Language options

2.7 Does your child have any known medical conditions? If yes please provide details/relevant documents

S.No. _______________

Admission No. _______________

Admitted in ___________ class

Date of issue of application :

(Admission process should be completed within one week of issue of application)

Date of submission :

Alumni

Sibling

General

Note -• Fill the form using a blue/black ball point pen in block letters.• Make sure all necessary and valid documents are attached along with the form• Please indicate the category to which you are applying with a tick mark in the relevant column.

Affix the latest Passport size

colour photograph of the student

f i r s t n a m e l a s t n a m e

1.

Class

a. b.

2.

School

d d / m m / y y y y

d d / m m / y y y y d d / m m / y y y y

Male

Science

Commerce

(a) II Language

(b) III Language

MPC IP/PE

MEC

Hindi

Hindi

BiPC IP/PE

AEC IP/PE

Telugu

Telugu

Sanskrit

Sanskrit

Others

(no change will be made later)

(no change will be made later)

(as per caste certificate)SC

CBSE

ST

ICSE SSC

OBC OthersBC - A/B/C/D/E

Female

Bowenpally Alwal Boduppal Gandipet Saroornagar Tivoli

p l a c e o f b i r t h

(Class V to VIII)

(Class VIII & above)

PALLAVI MODEL SCHOOLBOWENPALLY | ALWAL | BODUPPAL | GANDIPET| SAROORNAGAR | SECUNDERABAD | ATTAPUR | PUPPALAGUDA

www.pallavimodelschools.org | 1800 212 111111




SAMPLE ONLY

www.pallavimodelschools.org | 1800 212 111111 2

3.1 Details of parents

3.2 Name

3.3 Educational Qualifications

3.4 Profession

3.5 Designation

3.6 Name of the organization

3.7 Annual Income

3.8 Office Address

3.9 Residential Address

3.91 Mobile No, / Landline No.

3.92 Emergency Contact No.

3.93 E-mail ID

3.94 Details of sibling(s) studying in this School : (if applicable)

3.95 Guardian’s Name (if applicable)

Address

Mobile No.

3.96 Areas in which the parent can contribute as a stake holder in the student’s development

Section 3. Contact Details

FATHER MOTHER

fa t h e r ’ s n a m e w i t h e x p a n d e d i n i t i a l m ot h e r ’ s n a m e w i t h e x p a n d e d i n i t i a l(details once given cannot be changed)


colour photograph of the student’s

father

S.No Full Name Class & Section Admission No.

1.

2.

3.

Cultural ProfessionalMedical SportsMedia


colour photograph of the student’s

mother

SAMPLE ONLYSAMPLE ONLY


• I, the undersigned, hereby declare that I am the father/mother/legal guardian of Master / Miss applicant - student

• I promise to abide by the school rules and regulations and abide by any change of school timing, programmes, planning etc.,

• Registration fee is non refundable. Obtaining application form/applying online does not imply admission. Admission is subject to availability of seats. In case of withdrawal of admission, I am aware that I am not entitled for refund of any fee deposited, irrespective of when my ward was admitted. Only caution deposited is refundable. In case of withdrawal in the middle of the Academic Year, I will be paying the tution & transport fee also for that year.

• One term advance intimation to be given in writing for withdrawing transport facility/admission. In case of withdrawal of admission of my ward, the term fee and transport fee availed for that term will be borne by me. Transport fee or Term fee are neither refundable nor adjustable.

• In case of any damage/loss caused to the school property by my ward, the damage charges will be paid to the school to the extent of the cost applicable.

• Expensive articles/jewellery shall not be worn by students. School is not responsible for its loss.

• That the school reserves the right to expel my ward anytime, including the final external examination period for indulging in any act of gross misconduct/indiscipline. Also, that any action taken by the school on any matter concerning my ward will be final and binding on me.

• Pallavi Model School plies school buses on the fixed routes with limited stops. It will not be obligatory on the part of the school authorities to make new bus stops. It will be the sole responsibility of us to escort the pupil to and fro from the respective bus stop. I am aware that the routes and stops are subject to changes. I am aware that no request for pick up /drop of my ward other than the designated point and no request for travelling other than the designated route is accepted. I will respect the discretionary authority of the school to alter the bus route/bus stops as and when the need arises.

• I do understand that programming and philosophy of education at PMS is to emphasize overall development of the child along with sports, excursions and other co-curricular activities besides academics. I shall permit my ward to participate and fully cooperate with the school in this regard.

• I have no objection in receiving SMS from School. I give consent to use photographs of my ward in the magazines, flyers, prospectus, advertisements and other publications of the organization.

• I abide by the given fee structure. I am aware that there is a different fee structure within the class and also aware that it is subject to revision every year.

• I assure that the information provided in this application form is correct to the best of my knowledge. I will not request for correction/changes in name of my ward/ in our (parents) names and date of birth of my ward. I promise to abide by the school rules and regulations and abide by any change of school timing, programmes, planning, etc.

Having read carefully the above details, I hereby accept and endorse the above declarations.

Signature of Father Signature of Mother Signature of Guardian

Date :

DECLARATION



I do hereby agree and declare that

• My ward……………………………………… studying in class …………… of Pallavi Model School may be permitted

to take part in Inter School Sports or Co-curricular competition /any camp / course / adventure / training

/ treks / swimming / NCC / mountaineering / rock climbing / hiking / skating / cycling / horse riding /

yoga/ field trips/Excursions/or any adventure activities which involve risk, organized by the school for the

students’ practice / show / competition at all levels. I undertake and agree to hold the school and its staff

indemnified against all such claims that may arise out of any loss or fatal injury to the property or person

which my ward may suffer while or in consequence of participation in any such activity.

• I understand that the school shall take all possible efforts to ensure the safety of my child in the school /

school bus. Inspite of their efforts, in the unfortunate event of any injury/harm/accident/loss of life during

the course of stay of my child in school /school bus, I shall not hold the school or the authorities responsible

for the same.

• I understand that the school cafeteria is an optional facility and is outsourced to an agent. Though school

shall take all precautions of food safety and hygiene, however in case of any health ailments arising due to

this facility, I shall not hold the school or the authorities responsible for the same.

Father’s Name :

Mother’s Name :

Address :

Date :

Father’s Signature :

Mother’s Signature :

Place :

Undertaking



Our BranchesManikonda | Ayappa Society | Mahendra Hills | DD Colony | SuncityHabsiguda | Tarnaka | AS Rao Nagar | Bachupally | Kanajiguda

1. The child should be 2 ½ years of age as on 31st March for Nursery.

2. The child should be 3 ½ years of age as on 31st March for LKG.

3. The child should be 4 ½ years of age as on 31st March for UKG.

4. The child should be 5 ½ years of age as on 31st March for Class I.

Admission No. : ..............................................................................

Admitted to Class : ..............................................................................

Admitted to Stream (for Class XI / XII) : ....................................................

Date of Confirmation : ...............................................................................

Date of Admission : ...............................................................................

Fee Reciept No. & Date : ..............................................

Amount Paid : ..............................................

Activity Fee : ..............................................

Caution Deposit : ..............................................

Term Fee : ..............................................

Others : ..............................................

a) Birth Certificate (Original)

b) Transfer Certificate (Original)

c) Caste Certificate

d) Report Card of previous class

e) Passport size photographs x 5

f) Residential Proof

g) IX Class Registration details

h) Certificate of any special achievement

i) Others (if any) .....................................

j) Vaccination card/Evidence of vaccination

k) Aadhaar Card

Eligibility Criteria

Mandatory documents to be submitted during admission

For office use only

Principal’s Remarks

ADMITTED/REJECTED

Signature Manager / Accounts Assistant



OUR BRANCHES

PALLAVI MODEL SCHOOLBOWENPALLY+91 7032 9932 [email protected] to XII

PALLAVI INTERNATIONAL SCHOOL GANDIPET+91 70933 311 [email protected] to VII

PALLAVI MODEL SCHOOLALWAL+91 9396 956 [email protected] to XII

PALLAVI AWARE SCHOOL SAROORNAGAR+91 9100 1888 [email protected] to VIII

PALLAVI MODEL SCHOOL BODUPPAL+91 7660 0024 [email protected] to X

AKSHARA VAAGDEVI INTERNATIONAL SCHOOLTIVOLI+91 9573 4697 [email protected] to X






PALLAVI MODEL SCHOOL

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