Admission Form | Lumos Kindergarten

LUMOS KINDERGARTEN

ADMISSION FORM

LUMOS KINDERGARTEN

Rabbit Homes, Gamma Path,
Near Hanuman Mandir, Landmark - RPS Law College,
Danapur, Patna, Bihar - 801503
Call: +91 98354 75977

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LEARNER'S PERSONAL DETAILS

Form Number

Academic Year

Seeking Admission In

Full Name

Date of Birth

Blood Group

Nationality

Gender

Male Female

Mother Tongue

Other Languages

Name of Previous School

Any Special Learning Needs

Which medium does your child learn best with?

Auditory Visual Kinaesthetic Spatial

PARENT / GUARDIAN DETAILS

Details	Mother	Father	Guardian
Full Name
Educational Qualification
Profession
Designation
Organisation Name
Office Address
Office Number
Mobile Number
Email Address

SIBLING DETAILS

Sibling Name

Gender

Male Female

Grade

School Name

EMERGENCY CONTACT DETAILS

1st Priority Relation

Number

2nd Priority Relation

Number

3rd Priority Relation

Number

HEALTH FORM

Height

Weight

Family Doctor Name

Hospital Contact Number

Eye Test Record

Dental Record

Hospital Name & Address

Does your child take medications regularly?

Yes No

Medication Details

Any Dietary Restrictions

PHOTO / VIDEO CONSENT

I allow school to use child photos/videos for website/social media/brochures.

ABCD

I / We confirm that all the information provided by me/us is correct. I / We further agree to inform the school promptly of any subsequent changes. We understand that any incorrect information given by us may cancel admission.

Date

Mother Signature

Father Signature

Guardian Signature