Sl.No.:

Step in

(Admission Form)

Photo

Centre Location : (Franchise of EdFACT Learning Systems Pvt.Ltd)	Date :
Name of the Child :	Gender : Male Female
Residential Address :
Tel. :
Date of birth (in figure) :	Age :

	Father’s/Legal Guardian’s Details*	Mother’s Details*
Name :	:	:
Educational Qualification :	:	:
Professional Qualification :	:	:
Occupation :	:	:
Designation :	:	:
Organization :	:	:
Tel.(Resd.) :	:	:
Mobile :	:	:
E-mail	:	:
Relationship with legal guardian (Pls. specify if applicable)

Monthly Income(Rs.) :

25,000/-

25,000/-to 50,000/-

50,000/-to 1,00,000/-

>1,00,000/-

Child’s other interests ( Hobbies, Games, Dance or extra co-curricular activities) Please specify :

vaccination given :

Child Medical History :

Medicine being used by the child :

Child’s allergic to :

Does the children have any specific fear :

Yes

No

Languages child understands

List down the common words uttered by the child

Any other information

Would you like to be updated about the events & innovative programmes from “Little Ville”? Yes No

Yes

No

How did you learn about “Little Ville” ?

In case of emergency other than parents or guardian. A person who can take care of the child.

I CONTACT PERSON

II CONTACT PERSON

I/We hereby authorize “Little Ville” to use photographs, videos and crafts created by our children in

brochures, newspapers, websites and any other promotional meterial in perpetually.

I have read the school prospectus and agree to abide by the rules & regulations. I understand and

agree that registration of my child/ward is no guarantee for admission to the formal school.

Signature of Father

Signature of Mother

Signature of legal Guardian

FOR OFFICE USE

Fee Receipt No.:	Date:	Amount:
Date of commencement of classes :
Signature of Counsellor		Signature of Principal
Remarks:

Little Ville Preschool