DELHI PUBLIC SCHOOL, R.N.

EXTENSION
NH-58, MEERUT ROAD,MORTA, GHAZIABABD- 201003,
UTTAR PRADESH
Web: www.dpsrnext.com | Email: info@dpsrnext.com
Tel: +01202802000

REGISTRATION FORM FOR ADMISSION (2023 -2024)

Child's Photo
REGISTRATION NO. CLASS APPLIED FOR

2084 VII

STUDENT'S DETAILS

STUDENT'S NAME : SHIVAM PANDEY

DATE OF BIRTH : 31/05/2011 Age as on 1st April, 2023 : 11 Years 10 Months

GENDER : Male a Female Other

NATIONALITY : INDIAN ONLY CHILD : NO

BLOOD GROUP : A- RELIGION : HINDU

CASTE CATEGORY : GENERAL CATEGORY : GENERAL

SMS NUMBER : 7531033558 MINORITY : NO

EMAIL :

SIBLING DETAILS
DETAILS OF ANY SIBLING STUDYING (REAL BROTHER & SISTER) IN THIS INSTITUTION NO

S. No. Name Adm No. Class & Sec. presently studying in

1
2

RESIDENTIAL ADDRESS

A 901 AGGARWAL HEIGHTS RAJ NAGAR EXTENSION GHAZIABAD , PINCODE -201017

PERMANENT ADDRESS

A 901 AGGARWAL HEIGHTS RAJ NAGAR EXTENSION GHAZIABAD , PINCODE -201017

 PARENT'S DETAILS

FATHER'S DETAILS MOTHER'S DETAILS

Mother's Photo
Father's Photo
NAME : MR. N K PANDEY MRS POONAM PANDEY

QUALIFICATION : POST GRADUATION POST GRADUATION

DESIGNATION : NA HOUSE WIFE

OCCUPATION : GOVT SERVICE OTHERS

ORGANIZATION : CANARA BANK

OFFICIAL ADDRESS : RAJ NAGAR EXTENSION

MOBILE NO. : 7531033558 9953873558

EMAIL ID : pandey.mgc1@gmail.com pandey.mgc@gmail.com

GUARDIAN 'S DETAILS

GUARDIAN NAME :

ADDRESS :

QUALIFICATION : INCOME : 0

DESIGNATION : EMAIL ID :

OCCUPATION : ORGANIZATION :

OFFICIAL ADDRESS : MOBILE NO. :

PREVIOUS SCHOOL 'S DETAILS

NAME OF THE SCHOOL : SMCS

CITY NAME : GHAZIABAD

MEDIUM OF : ENGLISH
INSTRUCTION
SCHOOL : ICSE
YEAR OF PASSING : 2022
RECOGNISED BY
LAST YEAR
 SUBJECTS MARKS GRADE GRADE ACHIEVEMENTS IN PREVIOUS
POINT SCHOOL

ENGLISH

HINDI

MATHEMATICS

SCIENCE

SOCIAL SCIENCE

THIRD
LANGUAGE
DECLARATION BY PARENT
1. In the event of our child being granted admission in the school, I promise to follow all the rules and regulations of the school
conveyed to me from time to time.
2. I have been informed and am aware of the fee structure, along with the annual increment process of the school. I accept to pay
the dues on time, without any reminder from the school. I take complete responsibility and confirm that I will never be a
fee-defaulter.
3. I am aware that the fee available on the website is for the current session and it would increase between 6% to 9% in the upcoming
session as per the guideline of Fee Regulatory Act.
4. In case I am not able to pay the fee on time, the School Management reserves the right to withdraw its services for my child without
any notice or my consent.
5. I am aware that any fee once paid to the school is non-refundable and non-transferable and that in case I withdraw my child in
between the session, I will be liable to pay the fee for the existing quarter of the current year.
6. I will follow all the academic guidelines of the school provided to me by the respective teachers/ school representatives time to time.
I confirm that I will never involve myself in any anti-school activity and will seek school’s view point in case of any query.
7. I understand that the school is responsible for the overall conduct of the child and I assure that I will never interfere in the process
of school operations. I will always be present in case the school calls me for any suggestion/ improvement of my ward and will
always stand by the school, in case my child is reprimanded for any misconduct/ act of indiscipline.
8. I am aware that the school has its policy/ criteria of rewarding its students on various academic and co-curricular activities. I assure
that I will always accept the decision of the school and will never have any doubts or concerns over the decision of the School
Management.
9. I understand that developing a child is a responsibility of both the parents and the school, and I assure that I will give regular time to
my child and be always updated with his academic developments.
10. I assure that I will always be present in all the PTMs called by the school and will work on the feedback given by the school.
11. I will not misbehave/ use impolite language, harsh, derogatory words /scream & shout at any employee of the school.
12. I agree that the transport is an additional facility provided by the school and it all depends on the availability of seats for a child to
be granted that facility.
13. School holds the right to have its bus stops as per the guidelines of the Transport Department. I will not expect/ request for any
change in the transport plans after availing the services.
14. Transport routes/ bus/ bus driver/ cleaner/ bus in-charge may change without notice; it is complete discretion of the Transport
Department of the school.
15. If I wish to avail the transport facility of the school, I accept to pay the fee proposed for the transport every year.
16. The safety of the child in the bus while availing the transport of the school is the responsibility of the school, however, as a parent I
will always guide my child to follow the discipline and the safety measures best known to me.
17. If I avail any private transport, I will be completely responsible for my decision. I will never hold the school responsible for any risk
or consequences arising out of this arrangement made at my own will, outside the school premises.
18. I will also undertake that:
a) My ward will not indulge in any behavior or act that may be considered as ragging.
b) My ward will not participate in or abet or propagate through any social media any kind of defamatory posts about the
school or anybody involved with it.

Date : ............................... Signature :

Place : ............................... Name in Full (BLOCK LETTER) :

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Address:
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