JP ACADEMY
Shapping A New Future
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  Registration Form

 
Academic Session * :
     
Class Sought for Admission * :
Name of the Child * :
Email Address* :
Date of Birth * : ( Formate: DD/MM/YYYY)
Place of Birth :
Nationality * :
Religion :
Sex : Male Female
Caste :
RECORD OF PREVIOUS EDUCATION :
S. No. School Attended Medium of Instruction Year Exams Passed Reason for Leaving the School
1.
2.
3.
4.
Mention Hobbies / Interests / Games and Sports / Prizes won.


Has the Child been removed from any other school for disciplinary or academic reason.     Yes No
If yes, Please give details

Hostel accommodation required :     Yes No
Name of Father * :
Occupation of Father :
Name of Mother * :
Occupation of Mother :
Annual Income Rs :
Telephone No. (Resi.) * :
Full Postal Address of Parent with Telephone No. (Residence) *

Permanent Home Address

Upload Photograph :

 

    

 
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