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ST. PIUS X INTERNATIONAL SCHOOL-SPXIS Nahur, Mulund West, Mumbai – 400 080.

ADMISSION FORM

(20__-20__) Instructions:

 Please read the application form carefully before filling it.

 Admission granted on the basis of incorrect information will be null and void.

 Please fill the application form in BLOCK letters

 Please note that an incomplete Application Form will be rejected.

1. CHILD’S PERSONAL INFORMATION

Child’s Name: _______________________________________________________ (Surname) (Name) (Father’s Name) (Mother’s name)

Date of Birth: __________________

Place of Birth: ______________________________ Nationality: ______________

(Town & State)

Religion: ______________________________ Blood Group: ________________

Language Spoken at Home: ____________________________________________

Residential Address: _________________________________________________

___________________________________________________________________

PIN CODE __________________ Residential Contact No. ____________________

Please tick which is applicable: 0-1 km 1-3 km 3-5km 5-8km

above 8 km

Passport Photo of the Child

Level Enrolling for:

International Early Year Curriculum – Nursery (3 years completed as on 30th September)

International Early Year Curriculum – Jr. K.G. (4 years completed as on 30th September)

International Early Year Curriculum – Sr. K.G. (5 years completed as on 30th September)

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2. FATHER’S PERSONAL INFORMATION

Father’s Name: _____________________________________________________

Age: __________________ Mobile No.___________________________________

Email ID____________________________________________________________

Educational Details:

NAME OF THE INSTITUTION PLACE OF INSTITUTION

School

College

Professional

School Alumni (Past Pupil): If yes, year of passing _________________________

Are you closely associated with the school? YES No

If yes, in what way? __________________________________________________

Transferable Employees: Defence Income Tax Customs Police

(Govt. /Pvt. Sector) Sportsman Teacher Doctors Others

Name of the Organization:______________________ ______________________

Office Contact No.: __________________________________________________

Annual Income (Rs.):_________________________________________________

3. MOTHER’S PERSONAL INFORMATION

Mother’s Name: _____________________________________________________

Age: ________________ Mobile No._____________________________________

Email ID____________________________________________________________

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Educational Details:

NAME OF THE INSTITUTION PLACE OF INSTITUTION

School

College

Professional

Transferable Employees: Defence Income Tax Customs Police

(Govt. /Pvt. Sector) Sportsman Teacher Doctors Others

Name of the Organization: ____________________________________________

Office Contact No.: ____________________Annual Income (Rs.) _____________

Emergency Contact number for communication: __________________________

4. SIBLING’S INFORMATION

Siblings studying in St. Pius X (State) School: Yes No

(Real brother/sister only). If yes,

Class __________ Div. _____________ G.R. No. of Sibling ________________

5. PARENTAL ASSISTANCE:

We are keen to use talent and resources that are available in the school

community and that can enrich our school programmes.

Please indicate if you may be able to make any special contribution to

St. Pius International School-SPXIS such as:

Teaching of Music Dance Coaching Sports Other

If any other competence (please mention) _______________________________

1. Name of the Sibling ______________________________________ studying in

Class __________ Div. _____________ G.R. No. of Sibling ________________

2. Name of the Sibling ______________________________________ studying in

Mother’s Signature: __________________

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6. DECLARATION:

 We hereby declare that the information provided in this form is true to the best of our

knowledge and belief. We understand that if, at any stage it is found that we do not

satisfy the admission criteria or the information furnished by us is incorrect, our

application may be disqualified.

 We have read and understood that school rules and regulations with regard to

admissions and agree to abide by them. We understand that the decision of the school

with regard to our child’s admission will be final and binding upon us.

Father’s Signature: ___________________ Submission Date: _____________________

Guardian’s Signature: _________________

RULES FOR ADMISSION

 At no time and under any circumstances will, any request for a change of the date of birth is entertained.

 All documents once submitted become the property of the school and cannot be returned.

 The admission will be done by an “Admission Panel” and its decision will be final.

 Admission will be given as per availability of seats

SUBMITTED PHOTOCOPIES OF:

 Birth Certificate  Family Photograph

 Baptism Certificate (if any)  Caste Certificate (if any)  Aadhar Card 

 Ration Card 

Income Certificate Passport size Photograph

Submitted by: ______________________________________________________ (Name and Signature of the Parent)

Verified by: ______________________________________________________ (Name and Signature of the Teacher)

SUBMIT BY EMAIL

Surname: Name: Place of Birth: Nationality: Religion: Language Spoken at Home: Blood Group: Address 1: Address 2: Pin Code: Residential Contact No: Fathers Name: Year of Passing of Past Pupil: Group27: Off Mothers Name: Defence: Off Income Tax: Off Customs: Off Police: Off Sportsman: Off Teacher: Off Doctor: Off Others: Off Emergency Contact No: Music: Off Dance: Off Sports: Off Any other competence: Submission Date: Mothers Signature: Guardians Signature: Birth Certificate: Off Baptism Certificate: Off Adhaar Card: Off Ration Card: Off Family Photograph: Off Caste Certificate: Off Calendar Copy: Off Income Certificate: Off Verified by: Fathers Age: Fathers Mobile No: Fathers Email ID: Fathers School Name: Fathers College Name: Fathers Profession: Fathers Place of School: Fathers Place of College: Fathers Place of Profession: Group28: Off Name of Fathers Organization: Fathers Office Contact No: Fathers Annual Income (Rs: ):

Mothers Complete Name: Mothers Age: Mothers Mobile No: Mothers Email ID: Mothers School Name: Mothers College Name: Mothers Office Name: Place of Mothers School: Place of Mothers College: Place of Mothers Office: Mothers Name of Organization: Mothers Office Contact No: Mothers Annual Income (Rs: ):

Defence1: Off Income Tax1: Off Customs1: Off Police1: Off Sportsman1: Off Teacher1: Off Doctor1: Off Others1: Off Sibling Yes: Off Sibling No: Off Others3: Off Fathers Complete Name: Parents Complete Name: Passport Photo of the Child: Submit the form Via Email: Date of Birth: Name of Sibling: Name of Sibling #2: Sibling Class: Sibling Div: G R No of Sibling: Sibling #2 Class: Sibling #2 Div: G R No of Sibling #2: Parents Signature: Fathers Signature: Teachers Signature: Nursery: Off Jr: K: G: Off

Sr: K: G: Off

YEAR: YEAR2: