A.Y.

: 2023 - 24
PAWAR PUBLIC CHARITABLE TRUST'S Sr. No. : NC-12764
Std : 2
PAWAR PUBLIC SCHOOL
Nanded City, Sinhagad road,
Pune - 411041.
Ph.: 67506111 Fax : Website : www.ppsnandedcity.com

APPLICATION FORM FOR REGISTRATION

FOR ADMISSION

Student Name : Master Desai Sharvil Deepak

Last Name First Name Middle Name
Gender : Male Mother Tongue : MARATHI Place of Birth : KOLHAPUR Nationality : INDIAN

Date of Birth : 08/Nov/2016 8 11 2016

(in words) (Date) (Month) (Year)
Religion : Hindu Caste : MARATHA Category : GENERAL
Standard to which admission is sought : 2 Aadhaar Card No 382306947775
Name of the School and Standard in which the child is studying at present -
School : PODAR INTERNATIONAL SCHOOL Std : 1

Put a þ on ¨ ICSE þ CBSE ¨ SSC ¨ OTHERS ( þ recognised ¨ not recognised )

Father's / Guardian's Name : Desai Deepak Nivrutti Age : 32 years
Surname Name Father's Name
Mother's Name : Deepak Age :
Surname Name Husband's Name
Residential address of Parents : C204 MEGHSPARSH APARTMENT PUNE BANGLORE HIGHWAY OPPOSITE SWAMI
NARAYAN TEMPLEAMBEGOAN, PUNE, MAHARASHTRA
Pin Code : 411046 Living Location : Other Mobile 1: 9860271627
Tel.: (Res.) 9860858596 (Off.) 7666364012 Mobile 2: 9561800244 Email : [email protected]
þ OM
Please answer against the relevant category / categories.(Put a þ on YES / NO )

SIBLING DETAILS :

Sr. No. Student Name Father's name Mother's name Standard. Div.
1 - - - - -

Are you seeking admission for any other child/children of your own? If yes, fill in the following details :

Sr. No. Surname Name Father's name Std. Form No.

LIST OF SUPPORTING DOCUMENTS :

1) Four Photographs
2) Copy of Birth Certificate (Nursery - Std. I)
3) Residence Proof
4) Copy of Mark Sheet / Progress Report
5) Original Leaving Certificate (Std. II and Above)
6) Fitness Certificate from Registered Medical Practitioner
7) Copy of Caste Certificate (Optional)
8) Copy of Passport / PIO card (for students travelling from outside India)
9) Copy of Aadhaar card.
10) Previous School Bonafide Certificate (Std. II and above)
NOTES :

1) Original Documents to be produced for verification at the time of admission.

2) Forms will NOT be accepted if they are incomplete, without the supporting document or if original documents are not
produced for verification.
3) If the pupil has come from a different District / State, other than Pune district, the Transfer Certificate must be
countersigned by the appropriate Inspector concerned.
4) If the pupil has come from a different country, other than India, the Transfer Certificate must be countersigned by
the appropriate officer of the Indian Embassy / Consulate / High Commission in that country concerned. Documents
without this stamp will not be accepted and the admission will be provisional (up to 2 months), subject to the parents
providing the said documents.

Areas in which you would like to participate in the Parent - Teacher Association. Please indicate by a þ

¨ Celebration ¨ Newsletter and Publicity þ Co-curricular Activities

þ Computer / Software ¨ Excursions and Visits ¨ Sports

INFORMATION ABOUT THE PARENTS

FATHER MOTHER

1. Name : Mr. Desai Deepak Nivrutti Mrs. Deepak

2. Educational Qualification : BE PGP MBA

3. Mother Tongue : MARATHI MARATHI

4. Other Languages Spoken : ENGLISH

5. Religion : Hindu Hindu

6. Occupation : IT Professional

Profession / Business (give details)

a) Name of the Company/Organisation : VISHWAGURU INFOTECH

b) Designation / Type of Business : SR SOFTWARE DEVELOPER

c) Office Telephone no :

d) E-mail Address : [email protected]

e) Fax Number :

We assure the school that the information provided by us above is true and accept that if any of the information
is found to be incorrect in any way the school has right to cancel the admission.

Fill in the address for correspondence & bus pick up in given format only.

Date : 28-Mar-2023
Signature of Father Signature of Mother

Admission Co-ordinator : Online

Remark :

Date : Principal's Signature :

 PAWAR PUBLIC SCHOOL
A.Y. : 2023 - 24 Sr. No. : NC-12764

Student Name : Master Desai Sharvil Deepak Admission to class : 2

We acknowledge receipt of the duly filled admission form.

Date : Sign. :

Please attach the Results of prior year, compulsory for students seeking admission for STD I to X.
 PAWAR PUBLIC SCHOOL
MEDICAL HISTORY SHEET

Name of the Student: Master Desai Sharvil Deepak Sr. No: NC-12764
Age & Date of Birth: 08/Nov/2016 Class: 2
___________________________________________________________________________________________________
(To be filled and endorsed by a registered medical practitioner)
1. Name, Address, Contact No. and Regn. :______________________________________________________________
No of issuing authority : _____________________________________________________________
______________________________________________________________
2. Please share your child’s Birth and Developmental history:
a) Are there any significant birth details like pre mature/post mature birth, delayed birth cry etc.
____________________________________________________________________________ _______________________
b) Does your child have any difficulties in vision/ hearing/ speech. If yes, please specify:
____________________________________________________________________________ _______________________
c) Does your child communicate his/her basic needs through words?
____________________________________________________________________________ _______________________
d) Has the child undergone any psychological evaluation? If yes, kindly specify:
____________________________________________________________________________ _______________________
e) Has your child attended any therapeutic sessions like Speech or Occupational therapy?
____________________________________________________________________________ _______________________
3. Whether the child has suffered from any diseases like Diphtheria, Rheumatic fever, Typhoid, Tonsillitis, Epileptic
Fits, Filaria, Malaria, Enlarged glands in the neck, Mumps, Measles, Chicken pox, Whooping cough or such others:
_____________________________________________________________________________________________
4. Has he / she undergone any operations, if yes please specify:____________________________________________
5. Has there been any case of Tuberculosis in the family:__________________________________________________
6. Does the child suffer from any allergies or any other long term ailments:___________________________________
7. Is the child allergic to any medication:________________________________________________________________
8. Does the child require any special attention in academics or any physical activities? If yes, Pl. specify
___________________________________________________________________________________________________
9. a) Date of last vaccination :_________________________________________________________________________
b) Has he / she had a course of Triple antigen inoculation? :_______________________________________________
c) Has he / she had a course of Tetanus toxoid inoculation?: :______________________________________________
d) Has he / she had a course of Polio vaccines? :_________________________________________________________
e) What is the blood group of the child? :_______________________________________________________________
To the best of my knowledge the child is physically and mentally fit to join any regular school.

Date:_______________ _______________________ __________________________

Signature of Parent Sign of Issuing authority

Please Note:
· All students should have vaccinations once in three years.
· All children below the age of 10 years should have a course of Triple antigen.
· Children above the age of 10 who have not had Triple antigen should have a course of Tetanus toxoid.
· Children below the age of 10 should have a course of Polio vaccine.
· All students should take T.A.B inoculation against Typhoid every year, preferably in June
· Students should have regular dental check- ups and eye test at least once a year.
· If any of the above information is found to be false and incorrect, the child’s admission is liable to be cancelled.
· Follow-up, if any, recommended by the school physician should be necessarily attended to through your regular physician
 PAWAR PUBLIC SCHOOL
(Parental Consent Form)

The Principal
Pawar Public School
From: Mr. & Mrs. Mr. Desai Deepak Nivrutti and Mrs. Deepak
We, the parents of Master Desai Sharvil Deepak would like to request you for an admission for our ward in Std. 2 for the academic year 2023 - 24.
We understand the following rules and regulations of the school and assure you that if we are granted the admission we will abide by the same:
1. I am aware that the Fees paid for the first quarter at the time of admission will not be refunded except the Caution Money Deposit in the event of
cancelling the admission during the first quarter.
2. a) Application for withdrawal should be made in writing, mentioning the reason for withdrawal and the last working day and should be signed by both
parents/guardian (whoever has signed the admission form).
b) Application for withdrawal in writing has to be made 30 days in advance, before the actual date of withdrawal, failing which, one month’s fee, has to be
paid as notice fee.
c) The application of withdrawal has to be accompanied with an application for the refund of caution money along with the original caution money receipt
stating the name in which the refund cheque, has to be issued.
d) If the caution money receipt is lost / misplaced then the applicant needs to submit an affidavit stating that he/ she has lost the receipt. The notarized
affidavit has to be made on a stamp paper of ` 100/-
e) I will abide by the rules and regulations about fee policies of the school and accept the same.
3. It is the responsibility of the parents to pay the fee within 10 th of every quarter, failing which a late fee fine will be charged as per the rules of the school.
4. The allotment of shift for the Pre-Primary Section is at the sole discretion of the school. Kindly note that once admitted there will no change in the shift of
the child.
5. Admission granted for Grade 2 and above will be considered as ‘provisional admission’ till submission of the latest mark-sheet along with the Original
Leaving Certificate from the previous school before the end of June of the year of admission. Admission is subject to a passed & promoted certificate from
the previous school. In case the previous school is outside Maharashtra and/ or the student is studying in a school affiliated to another board, the student
should provide the Leaving Certificate which is countersigned by the Education Department. If the student is coming from abroad, then the Leaving/
Transfer Certificate should be countersigned by the Indian Embassy/ High Commission / Consulate of that country.
6. It is mandatory for the students to take part in all school activities and events. Students are expected to be present for all the school outings and
educational trips. Leave during the school term will not be granted except under the most extenuating circumstances.
7. I am aware that my ward is allowed to wear only the accessories (like tie, badges, etc.) which are prescribed by the school as part of the school uniform.
8. The school will take every care and precaution to safeguard the student during all its activities and school outings. However, in case of any accident or
mishap during any school activity or outing, I/we will not hold the school responsible for the same. All hospital/ medical charges for the same will be borne
by me.
9. It is the responsibility of the parents to check the school books and diary of the child on a regular basis and to attend to the teacher’s remarks if any.
10. The school does not approve of the pupils taking tuitions as it interferes with the curriculum of the school and it reserves the right to take strict
disciplinary action or violation of this policy.
11. In case transport arrangements are requires, it is mandatory to use the service provided by the school transport provider unless the school cannot
provide a route. Transport charges are to be paid directly to the service provider.
12. As far as Transport facility is concerned, the school will only be a facilitator (without any obligation), keeping in view the interest and safety of our
children and PTA / Transport Committee will be the sole authorized body to monitor these services. The Transport provider will be held liable for any
consequences arising out of any accident/ negligence or otherwise.
13. We are aware that this is a Private Permanently Unaided School and such schools have a right to fix their fees such that the fee amount covers all their
legitimate expenses. Hence we understand that the school fees are liable for hike. We agree to pay the same, as and when revised.
14. Admissions of siblings will be granted on the basis of availability of seats and not on the prerogative of parents. We undertake not to pressurize the
school for the same.
15. If I fail to submit all the supporting documents required by the school for granting admission to my child on or before _________________ , the school
will have every right to cancel my child’s admission.
We have read and understood the above rules and regulations of the school and the same are acceptable to us.

Date: Signature of Father/ Guardian Signature of Mother

 UNDERTAKING

To,
The Principal,
Pawar Public School,
Nanded City, Pune.

Dear Sir,

I, Mr. Desai Deepak Nivrutti and Mrs. Deepak , Parents

of Master Desai Sharvil Deepak is admitted to your school, in Grade 2

Division_______,________ for academic year 2023 - 24, would like to inform you that
we are aware that we are under obligation to pay the prescribed School Fee of our ward as
notified by the School through its circulars. The School Fees are liable for hike and we are agree
to pay the same.
We hereby assure you that fees paid by cheques shall be honoured on the due date. We are also
aware that dishonouring the cheque is a criminal offence. We are aware that the School can also
take action including but not limited to stopping online education/cancellation of admission
and issuing School Leaving Certificate. We also hereby undertake to pay the Fee within the
stipulated time as notified by School time to time henceforth. We also undertake that we shall
adhere to the Rules and Regulations of the School, failing which the School shall be at liberty to
take appropriate action. We have given this Undertaking voluntarily and we shall abide by this.

Thanking you.

Yours faithfully,

Father’s Name : Mr. Desai Deepak Nivrutti Mother’s Name : Mrs.

Deepak

Signature:_________________________ Signature:___________________________

Date :