Registration Form

Charoli Bk.via Lohegaon, Pune - 412105, Maharashtra, India
020 - 35037700 / 35037752 / 35037753 info@dypispune.in
Note: All '*' marked fields are mandatory. Please mention 'NA' if not applicable.

Proceed for Payment If Application form Already Filled.

Sibling if studying in D Y Patil International School, Pune

Admission No.

Sibling Name:

Sibling Class:

STUDENT DETAILS

Family Name:

Student's First Name:*

Student's Middle Name:

Gender:*

Date of Birth:*

Place of Birth:*

Academic Year:*

Grade Applying to:*

Category:*

Religion:*

Caste:*

Sub Caste: *

Nationality:*

Current Grade:*

Aadhaar Card No.:

Parent Mobile No.:*

Residence Telephone Number(s):

Curriculum of last School attended(ICSE/IB/SSC/CBSE/Other):*

Primary Email ID:*

Recent passport-size photographs:*

RESIDENTIAL ADDRESS

Address:*

City:*

State:*

Pin Code:*

COMMUNICATION ADDRESS

Address:*

City:*

State:*

Pin Code:*

Country:*

FATHER'S DETAILS

Father's Name:*

Nationality:

PAN Number:

Mobile No.:*

E-mail:*

Organisation/Company Name:*

Position / Title:Position / Title*

Office telephone (include country code if applicable) Phone(Off.):

Organisation Address:

Pin Code:

Father's Photo (Max-2 MB):*

MOTHER'S DETAILS

Mother's Name:*

Nationality:

PAN Number:

Mobile No.:*

E-mail:*

Organisation / Company Name:

Position/ Title:Position / Title*

Office telephone (include country code if applicable) Phone(Off.):

Organisation Address:

Pin Code:

Mother's Photo (Max-2 MB):*

SIBLING DETAILS

Name of brothers/sisters	Current school where sibling is studying	Date of birth (dd/my/yyyy)	Gender (M/F)	Are they applying to DYPIS?

FORM-A

STUDENT INFORMATION FORM (NURSERY TO GRADE V)

STUDENT BACKGROUND

Details of earlier School/ Schools Attended	Name of the School	Date From	Date to	Grade/Year	Lang. of Instruction	Board
Current School
Previous School (if any)
Past School (if any)

Why is your child leaving his/her current School?*

Why have you selected DYPIS?*

BIRTH AND EARLY CHILDHOOD INFORMATION

Where there any complications with your child's birth?

Were there any significant health issues in your child's first five years of life?*

Is your child adopted?*

Has your child ever had any difficulties with general coordination, balance and physical skills?*

My child is:

Has your child ever had difficulties with attention / concentration?*

HEALTH AND SAFETY

Are there issues we should be aware of relating to your child?

General health*

Eyesight*

Hearing *

Food allergies *

Please list any medication your child takes on a regular basis and its purpose:

LANGUAGE

What is your child's first language?*

If not English, how long has your child been learning English?*

Which language is spoken at home? *

In which other language is your child proficient?*

Has your child experienced any difficulty in acquiring language or vocabulary?*

Does your child receive extra help with his / her first language? *

ACADEMIC INFORMATION

What areas of the curriculum does your child particularly enjoy?*

What areas of the curriculum does your child not like or find difficult? *

Does your child enjoy reading?*

Has your child ever benefitted from additional support / small group support in school? *

Has your child ever been assessed for learning difficulties? (e.g. by an educational psychologist):*

Has your child been assessed as particularly gifted / talented? *

Has your child ever been suspended or had to withdraw from a school for disciplinary reasons?*

SOCIAL

Has your child ever received help for any social, emotional or behavioural issues?*

Does your child make friends easily?*

ACTIVITIES AND INTERESTS

Please list the main interests and activities your child enjoys and the approximate time spent on them each week .If any award or special recognition has been received, please mention it:*

Is there any other information that you want to provide that will help those teaching your child at DYPIS?*

Name of person completing this form:*

Relationship to student:*

FORM-B

STUDENT INFORMATION FORM (Grades VI to X)

STUDENT BACKGROUND

Details of earlier School/ Schools Attended	Name of the School	Date From	Date to	Grade/Year	Lang. of Instruction	Board
Current school
Previous school(if any)
Past school(if any)

Why is your child leaving his/her current school? *

Why have you selected DYPIS? *

LANGUAGE

What is your child's first language? *

If not English,how long has your been learning English? *

Which language is spoken at home? *

In which other languages is your child proficient? *

HEALTH AND SAFETY

Are there issues we should be aware of relating to your child?

General health *

Eyesight *

Hearing*

Food allergies*

ACADEMIC INFORMATION

What courses / subject does your child enjoy? *

What courses / subjects does your child not like or find particularly difficult? *

Has your child been assessed as particularly gifted/talented? *

Has your child ever been suspended or had to withdraw from a school for disciplinary reasons? *

Has your child ever been assessed for learning difficulties? (e.g. by an educational psychologist): *

In which country is your child likely to study at University level? *

SOCIAL

Does your child make friends easily?*

How does your child feel about the move to DYPIS?*

Has your child ever experience social, emotional or behavioural difficulties? *

ACTIVITIES AND INTERESTS

Please list the main interests and activities your child enjoys and the approximate time spent on them each week. If he / she has received any award or special recognition please mention it:*

Please comment if you have any reservations about your child's participation in school expeditions or the social service programme: *

Name of person completing this form:*

Relationship to student:*

APPLICATION CHECKLIST

The Following should be attached to this form for your application to be considered complete and ready for processing.

Photocopy of last school report card.
One recent passport-size photograph.*
Copies of extra-curricular certificates (if any).
Copy of Birth Certificate.*
Copy of Aadhaar Card.
Orignal TC to be scanned and uploaded and submit hard copy to school after confirmation of admission.

Completed form(s) as applicable:

Form A (Personal Details Nursery to Grade 5 to be filled by Parent).
Form B (Personal Details Grades 6 to 10 to be filled by Parent).
Form C (Student Statement Grades 8 to 10 to be filled by Student).
Form D (Health Information Form to be filled by Parent).

TERMS AND CONDITIONS OF ACCEPTING A PLACE AT DYPIS

I understand that failure to disclose all necessary information on the application form, concealing pertinent information and / or altering documents may result in any offer of my place being revoked and in the case of a place having been taken up, withdrawal from DYPIS.
I agree that my child will abide by the rules and regulations of DYPIS.
I agree to support the Vision of DYPIS as found on the School's Website and Brochure.
I agree to support the DYPIS policy regarding student uniforms.
I agree to attend parent-teacher-student conferences and to attend meetings the School may convene about my child.
I agree to pay the fees due to DYPIS in accordance with the fee schedule. Fees once paid are non-refundable and non-transferable. The admission and tuition fees are exclusive of Books & Stationery, School bus transport, Cafeteria, events like Annual concert, Sports Day, Winter Fiesta, charges for registration to external competitions and excursions and any other events as per school calendar.
I understand the DYPIS reserves the right to determine the placement of my child in the grade level or subjects judged most appropriate for the student's school experience and age.
I hereby agree and express my consent in the manner following:

to the participation of our said child / ward, in excursion organized by the school, both local and foreign.
we do hereby undertake to indemnify and save harmless the School, management and staff in respect of any liability arising in consequence hereof.

DYPIS reserves the right to terminate the enrollment of a student at any time if, in the judgment of the administration, the student's academic or disciplinary record, or conduct on or off the campus, is detrimental to the welfare of other students, or is not in keeping with the School's principles and standards. In such cases, there will be no refund of remaining tuition fees of the academic year and any unpaid balance will be due and payable immediately in full.

I Agree