This document contains a registration form for nursery admission to St. Paul's Church College in Agra. It includes personal details of the applicant such as name, gender, religion, caste, date of birth, parents' names and contact information. It also provides details of the applicant's current and permanent addresses. The parents provide undertakings that they will abide by the college rules, accept all fees and charges, and are responsible for their child's conduct. They also consent to their child participating in all college activities including religious instruction.

1. St.Paul’s Church College, Agra
Registration Form For Nursery
Form Number
*STPLC-1435*
For Office Use Only
Admit To Class & Section
Date
S.R.No
From To Be Submitted On 21 Oct 2016 at 3:30 PM by both parents alongwith child.
Personal Details
Name DHARSHIKA SINGH
Photograph
(Parents with child)
Size 48mm X 36mm
Gender Female
Religion Hindu
*(If christian then a Baptism Certificate Must be attached)
Caste GENERAL
*(If SC/ST/Backward. a certificate to be attached from the District
Magistrate or concerned authority)
DOB 25 Dec 2013
↓*(To be supported with the Orignal Birth Certificate and Countersigned Transfer Certificate from the previous school(If
applicable))
Name Domicile
Mother
Tongue
Father DR ANIL KUMAR SINGH UP HINDI
Mother SANGEETA SINGH UP HINDI
Father's Mobile 9412067548 Mother's Mobile 9045376559
Temporary Address
13 RADHIKA VIHAR COLONY NEAR BANKHANDI MANDIR BEHIND KK
NAGAR SIKANDRA AGRA
Permanent Address
13 RADHIKA VIHAR COLONY NEAR BANKHANDI MANDIR BEHIND KK
NAGAR SIKANDRA AGRA
Admission Sought in
Class
NURSERY
Last
Institution
Details of brothers/sisters(not cousins) studying in this college: (If not applicable please skip)
Name Class & Section
NA .
.
Details of brothers/sisters(not cousins) who have studied in this college:(If not applicable pls. skip)
Name Class & Section Year
NA 0 .
0 .
Details of ex-students applying for their child/ward: (If not applicable please skip)
Name Class & Section Year
NA .
.

2. Whether Parent's/Guardian's work may involve transfer ? NO
Occupation/Profession/Bussiness of Parents/Guardian:
Father/Guardian
Occupation:
DR BRA UNIVERSITY AGRA Post: ASSISTANT PROFESSOR
Salary 43500
Mother
Occupation:
HOUSE WIFE Post:
Salary
NOTE:- Both pages of this form are to be printed on a single sheet.
1. This application form is not transferable.
2. An incomplete, illegible or incorrectly filled application will be rejected.
3. Admission will be given :
a) . According to the availability of space/tests/interviews/interactive sessions.
b). With a view to maintaining the balanced composition of the College.
4. No scholar can be admitted without the original birth certificate from the concerned authority;
Transfer Certificate duly countersigned by the concerned authority/board.
5. The Principal is not bound to furnish any reason for admitting or rejecting an application.
UNDERTAKING BY THE PARENTS/GUARDIANS
We, the parents and / or guardians of DHARSHIKA SINGH hereby state that :
We will abide by all the rules and regulations of the College as mentioned in the school diary and as
amended from time to time.
We will give three month's notice or pay three month's fees in lieu of notice before withdrawing our
child / ward.
We accept all charges in the fee schedule.
We are willing to accept the decision of the Principal and staff with regard to admission and
Promotion.
In all disputes the decision of the Principal will be final and binding on us.
We will be responsible for the conduct of our child/ward. In case of any breach of discipline or neglect
of studies his/her name may be removed from the rolls of the College at the discretion of the Head of the
Institution.
In applying for the admission of our child/ward to St. Paul's Church College we indicate our agreement
with the 'spiritual Policy' of the College and consent to our child taking part in all College activities
including religious instruction and worship.
If, inspite of the normal precaution taken by the College, if mishap, accident or injury takes place
during the period of my ward's stay in the College or if and when he/she joins a tour, excursion or camp,
I will not hold the institution or any member of the staff wholly or partially responsible for it.
We undertake to intimate promptly any change of address to telephone number and will co-operate
with the College authorities in the observance of all College rules.
We hereby confirm that the date of birth given above is correct and that no request for a change in this
date will be made at any time.
Father's Name: DR ANIL KUMAR SINGH Signature ..................................

3. Mother's Name: SANGEETA SINGH Signature ...................................
Guardian's Name: Signature ...................................
Date:01/10/2016 Place: Agra