Form Test Page – Panchsheel Public School

REGISTRATION FORM

Name of the Child*

First Name

Last Name

Class*

Class

Date of Birth*

Child Date of Birth

Gender*

Religion*

Is the Child suffering from any illness or has any allergy ?*

If Yes, Please give complete details otherwise you can skip this Text Box

Residential Address*

Pincode

Father Name*

Prefix

First Name

Last Name

Father's Mobile Number*

Father Occupation*

Father Email address*

Mother Name*

Prefix

First Name

Last Name

Mother's Mobile Number*

Mother Occupation*

Sibling Name

First

Last

Class

Admission Number

Sibling Name

First

Last

Class

Admission Number

Name of the person with Mobile Number who is submitting this Form and his relation with the Child *

Are you human?*

This field should be left blank