Birla Balika Vidyapeeth, Pilani (Rajasthan)

(Girls Public School)

SCHOOL ADMISSION FORM
For Office Use Only

R. No. ………………. Date………………… Rs………………. Signature…………………

1. A/c No. …………………….. 2. Scholar No……………………….

1. Name of the student (in capital letters) ...........................................................................................

2. Date of Birth ...................................................................................................................................
3. Father’s Name/Guardian’s with occupation (in Capital letters) .....................................................
..........................................................................................................................................................
4. Mother’s Name with occupation .....................................................................................................
5. Permanent Postal Address (in capital letters) .................................................................................
..........................................................................................................................................................
6. E-mail Address ……………………………………………Cell. No. ............................................
7. Telephone no. (with STD Code) Resi .............................................................................................
Office. …………………………………..Fax No ..........................................................................
8. Class in which admission required .................................................................................................
9. Date of admission ...........................................................................................................................
10. Last school attended ........................................................................................................................
11. Copies of certificates enclosed (Tick proper column):

a. TC Original
b. Migration Certificate
c. Mark sheet (Xerox)
d. Date of Birth Certificate
12. Name of the visitors who can meet the girls with the authorization letter duly signed by the
parent/guardian with photo identity.
a.
b.
c.
d.

13. Name of the local guardian (with address) if any ...........................................................................

………………………………………………………Cell/ Tel. No.................................................

14. Person to be contacted in case of emergency

Name …………………………………………. Address ...............................................................
………………………………………………… Cell/ Tel. No. ......................................................

Date ………………………… Full signature of both the parents

(if guardian/relationship with student)

Father’s Name …………………………… Father’s Signature

…………………….

Mother’s Name …………………………. Mother’s Signature

……………………

Admitted to class ………………………..

Principal
 AGREEMENT

I ………………………………………………. S/o .............................................................................

Age …………….. Profession ………………………………. Resident of .........................................
…………………… Distt. …………………………..… father/ guardian of my daughter/ ward ........
…………………………………………………………. have read carefully the rules and
regulations of Birla Balika Vidyapeeth (Girls Public School) laid down in the school prospectus
and having admitted my daughter/ward to Birla Balika Vidyapeeth (Girls Public School) Pilani,
I agree to abide by the rules and regulations of the school, and hereby execute this agreement on
behalf of myself and my daughter/ward as under:
1. I bind myself and my daughter/ward to abide by the school rules and regulations in all respect
viz rules/regulations, which may be changed by the school from time to time.
2. In all matters of dispute, the decision of the Principal, Birla Balika Vidyapeeth (Girls Public
School) will be final and binding on me and my daughter/ward.
3. In accordance with the rules of the school, I agree and authorize, the participation of my
daughter/ward in all programmes of the school including tours, treks, camps etc. during her
stay at the school at my cost and risk.
4. I agree to hold the school indemnified against all claims arising through illness, accident loss
or any other cause of my daughter/ward and I or any relative of heir of my daughter/ward shall
have no right to file any claim against the school regarding her illness, loss or any other cause.
5. I authorize that, Principal, Birla Balika Vidyapeeth (Girls Public School) and through her
the staff to act in loco parents of my daughter/ward while in the school or on tours, treks,
camps etc.
6. I authorize the Principal, Birla Balika Vidyapeeth (Girls Public School) to take necessary
action on my behalf in any emergency, surgical operation or any other such condition where
my permission is needed but cannot be obtained in time.
7. I agree that in the event of my daughter/ward being withdrawn during the course of the year
whatever the reason may be, the full fees charged by the school for the whole year will be paid
by me.
8. The Principal, Birla Balika Vidyapeeth (Girls Public School) is fully empowered to remove
my daughter/ward if, in her opinion my daughter/ward has failed to maintain the discipline of
the school and her further stay in the school is detrimental to the interest of the other students
of the school and/or my daughter/ward fails to come up to the academic standard of her class.
9. If my daughter/ward is found accused or guilty of any criminal charge or misconduct or
persistent negligence of work or misbehavior, the Principal, Birla Balika Vidyapeeth (Girls
Public School) may remove or rusticate her from the school and hostel.
10. I understand and agree that the legal jurisdiction, for any legal dispute pertaining to the school
will be the Court, at Pilani.
11. I promise that my daughter/ward will not keep any valuable jewellery, electrical appliances,
especially cell phones, heavy cash, electronic items or any other risky article with her in the
hostel. If found, strict action can be taken against her.
12. I understand that the school may increase the fees during the session due to increase in the
expenditure in running the school. Therefore I hereby agree to pay any such increase in the fees
during the academic session.
13. Fee once deposited will not be refunded in any case.

FULL SIGNATURE
(If guardian relationship with student)

Father’s
Signature……………………
Accepted

Mother’s
Signature…………………...

PRINCIPAL