5216219

Nursery For 2022 - 2023

5216219

8F2F2F

20 Oct 2021 1:00PM

YUTICHAUDHARY

04 Jan 2019 Indian

HOUSE NO. 2848 GROUND FLOOR SECTOR 57

GURGAON Haryana 122003

6.00 KM. 8800897922 8800897922 nageshwarchaudhary@powergrid.in

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POWERGRID colleague

Sector 43,Gurgaon

1

Admission Sought in ……………………………………………

Date For Submission Of Form………………………………... Time ………………… Venue ………………...........……………… SI. No. ……………….

Last Name of Child ………………………………………………………………….. First Name of the Child ………………………………………..………...

CHILD (APPLICANT) FATHER MOTHER

SIBLINGS

CHILD INFORMATION

Date of birth …………………… Nationality ……………………. Gender Male Female Category SC ST Gen

Child with Special Needs Yes No Percentage …………………… Authentic Certificate Available Not Available

Specification …………………………………………………………………………………………………………….................................................................

……………………………………………………………………………………………………………………………...................................................................

Complete Residential Address ………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………...................................................................

Residence Distance From School ………........Tel. No. ……..…………..…… Mobile ………....………..…. Email ……………………………………….

Is there any medical information about your ward which the school should be aware of ……………………………………………………………….

Are you single parent Yes No

Whether school transport required Yes No

If Yes ,Your Residence on school transport route Yes No

If No, Are you in a position to provide safe transportation to the child to and from the school Yes No

Name of previous school / pre-school / Nursery / Cre'che …………………………………………………………………………………………………….

Period of stay, From ………………..…To……………….…

How did you learn about Amity?

Through Word of mouth ………………………………………………. Through Newspaper Advertisement …………………….............................

Through Internet/website ……………………………………………… Through Preschool ……………………………………………………...…….

Through Social Media …………………………………………………. Any Other ………………………………………………………………..…….

Sr. No. Admission No. Name Class School

Registration Form

Regn. No. …………………….

Password …………………….

ite

MUNNI CHAUDHARY Indian 02 May 1983

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Not Working Housewife Experienced Level

0

X.. MADHODAS SNSKRIT H/S ROUAHI, MADHUBANIBIHAR SNSKRIT SIKSHA BOARD, PATNA1999

XII.. K S COLLEGE LAHERIASARAI BIHAR INTERMEDIATE EDUCATION COUNCIL PATNA2001

NAGESHWAR CHAUDHARY Indian 28 Jan 1976

02 Nov 2006

Government/Public Sector Employee Energy/Mining/Mechanical Middle-Level Management

POWERGRID DGM

3000000

0129-2666461 8800897922 nageshwarchaudhary@powergrid.in

POWERGRID, SCO Bay 5-10, near Haryana Pollution Control board Office, Faridabad, 121002

Faridabad Haryana India

X.. R J HIGH SCHOOL NAVNAGAR BIHAE SCHOOL BOARD, PATNA Pat 1991

XII.. D N Y COLLEGE MADHUBANI BIHAR INTERCOUNCIL PATNA 1993

B Sc. En.. B C E BHAGALPUR T M BHAGALPUR UNIVERSITY 2002

M Ttech .. I T BHU, VARANASI BANARAS HINDU UNIVERSITY, VARANASI2004

2

PARTICULARS OF MOTHER

Full Name......................................................................................... Nationality ………………………………………. Date of birth ……………………...

Is the job Transferable Yes No Date Of Joining ………………………………… Income (INR/Annum) ……………………..

Occupation……………………………………Nature of Business …………………………………………………Level ………………………………………

Organization working for…………………………………………..………………………………………… Designation …………………………………….

Tel. No. ……………………………………………… Mobile ………………………………..……… Email ………………………………………………..……..

Office Address ………………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………………………………......

Educational Qualifications

Education Institution attended Board / University Year

Whether an Alumni of any Amity Institution? Yes No

Name of the Institution………..…………………………………….... Name the course of study you underwent………….…….…..…………………….……

Mention the period of study……….…..……………………..……..... Highlight your achievements, if any………………………..…………………………….

PARTICULARS OF FATHER ……………………………………………………………………………………………….

Full Name......................................................................................... Nationality ………………………………………. Date of birth ……………………...

Is the job Transferable Yes No Date Of Joining ………………………………… Income (INR/Annum) ……………………..

Occupation……………………………………Nature of Business …………………………………………………Level ………………………………………

Organization working for…………………………………………..………………………………………… Designation …………………………………….

Tel. No. ……………………………………………… Mobile ………………………………..……… Email ………………………………………………..……..

Office Address ………………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………………………………......

Educational Qualifications

Education Institution attended Board / University Year

Whether an Alumni of any Amity Institution? Yes No

Name of the Institution………..…………………………………….... Name the course of study you underwent………….…….…..…………………….……

Mention the period of study……….…..……………………..……..... Highlight your achievements, if any………………………..…………………………….

……………………………………………………………………………………………………………………………………………………………………………..

NAGESHWAR CHAUDHARY FATHER Indian 28 Jan 1976

-

Government/Public Sector Employee Energy/Mining/Mechanical Middle-Level Management

3000000

X.. R J HIGH SCHOOL NAVNAGAR BIHAE SCHOOL BOARD, PATNA Patna 1991

XII.. D N Y COLLEGE MADHUBANI BIHAR INTERCOUNCIL PATNA 1993

B Sc. En.. B C E BHAGALPUR T M BHAGALPUR UNIVERSITY 2002

M Ttech .. I T BHU, VARANASI BANARAS HINDU UNIVERSITY, VARANASI2004

Master in Civil Engineering from IT BHU, Varanasi

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Moral Values & Ethics, I am well versed in Physics, Chemistry and Math

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no

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3

PARTICULARS OF GUARDIAN

Full Name.........................................Relation to Candidate ………………………… Nationality …………………… Date of birth ……………………...

Is the job Transferable Yes No Date Of Joining ………………………………… Income (INR/Annum) ……………………..

Occupation……………………………………Nature of Business …………………………………………………Level ………………………………………

Organization working for…………………………………………..………………………………………… Designation …………………………………….

Tel. No. ……………………………………………… Mobile ………………………………..……… Email ………………………………………………..……..

Office Address ………………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………………………………......

Educational Qualifications

Education Institution attended Board / University Year

Are you in a position to personally support Amity’s objective of developing Quality Education in the country. Yes No

If Yes, Give Reason ………………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………………..

What is your area of expertise that will contribute to the school ethos of nurturing talent in your ward?

……………………………………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………………………………………..

One of Amity’s objectives is excellence in sports. Have you ever been a part of any sports activity on the state, national & international

level? …………………………………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………………...

DOCUMENTS ATTACHED

1. Date of birth certificate 2. Residence proof 3. Proof of transfer

4. Alumni proof 5. Proof of sibling

SIGNATURES

I hereby certify that the information given in the Registration form is complete and accurate. I Understand and agree that misrepresentation or

omission of facts will justify the denial of admission, the cancellation of admission, or expulsion.

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Signature of Father / Guardian Signature of Mother / Guardian

Date : Date :

Note :On the day of submission of form you have to bring the print out of the Registration form with photographs and self-attested copy of the child's

birth certificate issued by the Municipal Corporation, residence proof and occupation proof of both the parents.

5216219 8F2F2F Nursery

2022 - 2023 YUTI CHAUDHARY

72402553279 14 Oct 2021

4

Regn. No. ……………………….… Password ………………………….. Class ……………………….

Session …………………………… Child’s Name ………………………………………………………..

Date of Submission of form……………….Time ……………..Venue …………..… SI. No………….

Transaction No. ………………………………………………………………..…. Date ………………..

Date of receipt …………………………………. Signature ………………………………………………

CHILD (APPLICANT)

Registration Slip

Space For

Photograph (Passport Size)

Write

Registration No.

on the back before

affixing