Registration form

Jyothi Nivas School for the Visually Challenged Children

Karunagiri Nagar, Naidupet -507 003, A.P.

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Date of Application:……/……/……..

1. Name of the student:……………………………………………

2. Date of Birth:………………………………..

3. Name of Parents/ Guardian:………………………………………………..

4. Relation: ………………………………..

5. Profession: Father……………………………Mother…………………………

6. Contact Address:…………………………………………………………….

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7. Tel/Mob:…………………………..

8. Present Address:…………………………………………………………….

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9. Religion: …………………………………10. Caste:………………………

I agree with the rules and regulation of the School.

Parent/ GuardianSignature

OFFICE USE

Admission

Telugu / english

1. Date of Birth Certificate

2. Medical Certificate:

3. Income Certificate (Govt):

4. Caste Certificate (Govt):

5. Passport Size Photos Six: