Registeration Form

SAMARITAN
RESIDENTIAL SCHOOLS
REGISTRATION FORM

ADMISSION FOR THE YEAR 20 - 20

First Name *

Last/Family Name*

Middle/Other Names*

Date of Birth*

Age (on June 1st)*

Sex*

Male Female

Mother Tongue*

Father’s/Guardian’s Name*

Mother’s Name *

Present School (if studying) *

Class/Grade/Std.*

Admission For Class/Std. *

School*

Public CBSE Matriculation Higher Secondary

Hostel Admission*

Required Not Required

Name of Financial Provider *

Profession/Occupation*

Annual Household Income*

Address for Postal Communication *

Phones Residence *

Office*

Mobile/Cell Phone *

Email*

Name(s) of Siblings applying to Samaritans (if applicable) *

Class*
Class*
Class*

Additional Information, if any REFERRED BY *

I, hereby, declare that the above information is true and correct. I wish to register my child for admission in Samaritan Residential Schools for the academic year 20 - 20 .

Date

Signature of the Candidate

Place *

4/122 Samaritan School Road, Carmel Nagar,
Mangalam Village, Elagiri Hills - 635 853
Tamil Nadu, INDIA
Phone: +91-7305765469 and +91-9962765469
admission@samaritanschool.com
www.samaritanschool.com