APPLICATION FORM

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General Information *Indicates Mandatory Fields (Write NA if not applicable)

*Board Applying For :
*Academic Session :
*Class Applied For :
*Programme Applying For :
*Current Board :
Previous Admission No :
(Applicable only for the Heritage students)
*Subject Language Preference :
*Admission Category :
*Caste :
Do you belong to Minority Community :
*First Name :
 Middle Name :
 Last Name :
*Gender :
 A few words about your child :
*Date of Birth (in Figures) : Calendar
 (In Words) :
 Age on 1 April,   Years :    Months :   
*Nationality :
Applicant Aadhaar No. :
 Mother Tongue :
*Do you want to avail meal facility :
*Do you want to avail transport facility :

Parent Details *Indicates Mandatory Fields
*Relationship (as per birth certificate) :  
*
*
*First Name :  
  Middle Name :  
  Last Name :  
  Date Of Birth : Calendar Calendar
*Education Qualifications
  (Please mention institutions
   & school attended) :


*Occupation :  



*Organization where you work :  

*Designation :
*Mobile No :
*Email Id :  
  Phone(Residence) :
*Any Disability :  
*Primary Contact :  
Annual family income in Rupees :  

Current Address *Indicates Mandatory Fields
 
*Current Home Address :
 
*City :
Note : City "Gurgaon" has been renamed to "Gurugram".
 
*Sector :
 
 Country :
 
 State :
 
 Pin Code :
 

Previous School Information *Indicates Required Fields (Write NA if not applicable)
Add Previous School Information
School NameReason For LeavingDuration FromDuration ToTC submitted dateTown&DistrictAffiliated ToLast Class AttendedMediumCGPA/ %( Assessment of Previous/ Present grade )Delete
* Calendar Calendar Calendar


Sibling Information
No. of Siblings of the Child :  
(Sibling Details at Heritage Xperiential Learning School (if any))
If Twin Sibling has been Applied for :  

Sibling Details at Heritage Xperiential Learning School Add Sibling
Admission No.NameClass Currently Studying inFather NameMother Name

ALUMNI DETAILS IF APPLICABLE - Please fill this section if you have been an alumnus of The Heritage School of either Gurugram, Rohini or Vasant Kunj branches.
Year of Passing Out/Leaving :
Last Class Attended :
Name of The Branch :

CRC (Cumulative Record Card) DETAILS *Indicates Mandatory Fields (Write NA if not applicable)
DEVELOPMENTAL MILESTONES   Details if Any
*Started Walking  

 
*Started Speaking - One Word  

 
*Started Speaking - One Sentence  

 
Any Medical Condition   Details if Any
*Any Medical Condition  






 
Any Specific Intervention Provided   Details if Any
*Any Specific Intervention Provided  




 
Any Sensory exceptions   Details if Any
*Any Sensory exceptions  


 

Note : This is to inform you that we have an Enrichment Centre for Special Education Needs. However, it may not be equipped to handle a large number of children or certain kinds of difficulties.

Declaration by the parent *Indicates Mandatory Fields
In the event of admission, I declare to adhere to the following :
* A Pupil will be allowed to attend the class only after submitting a School Leaving Certificate, Municipal Certificate of Birth (Original along with photocopy), other relevant documents, fees and other charges as per the fee schedule.
* Parents are requested to ascertain if the school bus routes/scheduled stop is convenient for their ward before making payment of fee and other charges. No request for relocation of stop and/or change, extension, diversion in bus route will be entertained.
* Admission in our school does not mean allocation of a seat in the school bus. For this a separate application form is to be filled in and permission is to be obtained.
* Bus fee is charged for eleven months.
* Bus facility shall only be up to the pickup/ drop points as shall be intimated in the bus schedule. The parent/ guardian shall be solely liable to arrange for their ward to be picked up/ dropped at the pickup/ drop location in a timely manner.
* Refund of fees and other charges, after admission is accepted will be made as per school policy.
* Caution money should be claimed within six months of leaving the school.
* I hereby undertake to deposit all school fees as per school rules and schedule. I also confirm that I have read and understood the instructions regarding fee payment given by the school.
* The fees do not include the extra costs for Speech and Language Therapy, Occupational Therapy or screening tests as required and identified by school authorities, for any intervention needs or special needs. If I choose to do this therapy outside, I would submit programs, assessments and reviews by certified professionals to the school as required.
* The school has my permission to take my ward for any outing during the school hours. A separate permission slip from me is not needed.
* I understand that as a matter of discipline for my child and his academic progress the decision of the principal is final.
* I shall abide by all the rules and regulations of the school.
* I understand that, in case of any indisposition/injury/mishap, the school shall provide first-aid to my ward and I shall be informed. In case of any emergency, my ward will be referred to the nearest hospital and I shall bear all expenses thereof.
* I will inform the school immediately in case of any changes in the details given above.
* The school offers program for children with Special Education Needs. However, it may be equipped to handle a limited number of children and only certain kinds of difficulties if identified post admission. Intervention / admission to SEN program would be based on vacancies.
* I declare that the above information is true and correct and nothing has been concealed therefrom. I understand that the admission granted to my ward by the school will be cancelled if the same is found to be misrepresented.
 
Signature of Mother       Signature of Father
Date
Note: Please write to erp.support@ggn.hxls.org for technical issues.
 
Sibling Details at Other Schools
Add Sibling
NameAgeClassSectionName of the InstitutionSince when


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Do you live in a nuclear, joint or extended family situation?
(If other, please specify) :  


Please spend a few minutes to reflect and answer these questions...
1. Think of the time when you were in school. How was the whole experience? what did you like/dislike about your school education?
a. For father :  
b. For mother :  
2. What kind of education would you like your child to get ?  
3. How much time do you spend with your child daily? And in     what ways?  
Please attach the below Documents
Birth Certificate :  
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Address Proof :  
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Income Proof attested by the Sub-Divisional Magistrate :  
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Permanent home address :