to download the Application form - Brindavan Public Schools

APPLICATION FOR REGISTRATION
COONOOR ATHUR KODAIKANAL
(Please any one)
(Use Capital Letters)
1. Name of the pupil in full ……………………………………………………………………………….
2. Date of birth……………………………………………………………………………………………..
(Documentary evidence of age-birth extract from the Municipality / Panchayat Union or the Baptism
Certificate or a Transfer Certificate MUST be produced at the time of admission. Horoscopes will not
be accepted) Date once entered cannot be altered under any circumstances.
3. Age (next birthday) …………………………………………………………………………………….
4. (a) Last School attended and class……………………………………………………………..
(b) Date of entry into the school………………………………………………….......................
(c) Medium of instruction …………………………………………………………………….......
5. Class to which admission is sought………………………………………………………………......
6. Is the Transfer Certificate from the last school attached?
Yes No (Please )
7. Father's name …………………………………………………………………..................................
If Father is not alive, Mother's name…………………………………………………………….…...
Nationality…………………………………………………………………………………………..……
Occupation……………………………………………………………………....................................
Monthly Income………………………………………………………………………………………...
Address………………………………………………………………………………...........................
………………………………………………Telephone No…………………………………………...
8. Religion……………………………………………...…………………………...................................
9. Second language……………………………………………………………………………………….
10.Third language…………………………………………………………………………..………………
11.Mother tongue…………………………………………………………………………….…………….
12.Details of any relatives (brothers, sisters etc.) studying in the school……………………………
…………………………………………………………………………………………………………….
13.Details of relatives (brothers, sisters etc.) who are old students of the school……………...……
14.Name of local guardian, if any, who can visit the child and take the child out during
holidays/weekends…………………………………………………………………………………………
………………Address…………………………………………………………………………...…………
…………………………………………………………………………………………………….…………
………………………………………………………….Telephone No ……………………..…
I hereby request the Principal to reserve a place in the school for my son/daughter/ward for the
session beginning June or it there is no immediate vacancy, to register his/her name on the waiting
list.
I enclose herewith the registration fee of Rs 1200/-. I declare that I have carefully read the
prospectus and will abide by the rules laid down therein and accept that they can be changed from
time to time at the discretion of the school management. I clearly understand that it is the
fundamental policy of the school to treat all children alike. I shall, therefore, neither ask for nor
expect any privilege or concessions for my son/daughter/ward
.
Date of application:
BRINDAVAN PUBLIC SCHOOL
* Signature of parent/guardian
(The registration fee is not refundable. Registration carries no guarantee of admission. Admission
is confined to children between the ages of four and thirteen and is based on the priority of
registration. * Will be signed by father if alive or by the mother. Guardian will sign only if neither
father nor mother is alive or if a special authorisation is given by the mother, if father is not alive.)
(Subject to Chengalpattu jurisdiction.)

BRINDAVAN PUBLIC SCHOOL
MEDICAL CERTIFICATE
A. GENERAL.
1. Name of pupil in full……………………………………………………………………………………..
2. Age…………………………………………………….Sex : Male Female (Please )
3. Height…………………………………cms
4. Weight………………………………....
5. Any previous illness, their nature and duration………………………………………………………
6. Any previous injuries, accidents……………………………………………………………………….
Present condition………………………………………………………………………………………..
7. Any operation undergone and the result……………………………………………………………...
8. Any history of malaria or any other fever……………………………………………………………..
9. Date of last vaccination…………………………………………………………………………………
T.A.B……………………………………..Cholera……………………………………………………...
If triple antigen has been given, when the last booster dose was given…………………………..
B. RESPIRATORY SYSTEM
1. Respiratory rate at rest………………………………………………………………………………….
2. Range of chest expansion……………………………………………………………………………...
3. Any history of breathlessness………………………………………………………………………….
4. Any history of chest pain………………………………………………………………………………..
5. Any history of asthma, pleurisy or bronchitis…………………………………………………………
C. CIRCULATORY SYSTEM
1. Pulse rate at……………………………………………………………………………………………...
2. Blood pressure…………………………………………………………………………………………..
3. Any history of giddiness or fainting attacks…………………………………………………………..
4. Any history of palpitation
5. Any history of pain over heart region
6. Are the veins in any part enlarged or varicosed
D. ALIMENTARY SYSTEM
1. Any history of dysentery or jaundice…………………………………………………………………..
2. Any history of hernia (If so, operated or not)…………………………………………………………
When was it operated? Any complaints after the operation………………………………………..
3. Any history of appendicitis (if operated, the present condition)…………………………………….
4. Any history of recurring pain after the operation……………………………………………………..
5. Any history of renal or intestinal colic………………………………………………………………….
E. NERVOUS SYSTEM
1. Any history of epilepsy or any other fits……………………………………………………………….
F. BONES & JOINTS
1. Any injury or accident is the present condition without any complaint………………………….....
2. Any history of rheumatism……………………………………………………………………………...
3. Condition of toes and feet………………………………………………………………………………
G. URINE EXAMINATION
1. Is sugar or albumin present…………………………………………………………………………….
In my
opinion………………………………………………………………………………………………………
Date :………………………………
Place :……………………………… Signature of The Medical
Officer