Modern Academy - Register

Class (2000 - 2001)	Third Fourth Fifth Sixth

Particulars of Student

First Name

Middle Name

Last Name
Email Address

Gender	Male Female

Date of Birth	Year

Age on 30/08/2000	Days Months Years

Nationality

Mother Tongue

Permanent Address







Phone	Country Area

Postal Address







Phone	Country Area

Current School

Current Class

Name of sibling, if any, applying for admission

First Name

Middle Name

Last Name

Particulars of Parents

Father's Name

Father's Education

Father's Occupation

Office Address







Phone	Country Area

Home Address







Mother's Name

Mother's Education

Mother's Occupation

Office Address







Phone	Country Area

Home Address







Particulars of Guardian

Guardian's Name

Guardian's Education

Guardian's Occupation

Office Address







Phone	Country Area

Home Address







Registration Payment Details

Rupees One Thousand / US$100 only paid as non-refundable registration charge vide Cash DD

A/C Payee Bank Draft No.

Date

Bank

Branch

Declaration

1. I agree to abide by the rules and regulations governing the admission procedure

2. I solemnly confirm that the information given above is correct and true to the best of my knowledge.

3. I understand that any form of recommendation shall disqualify my ward.

Date