(Affiliated to C.B.S.E.)
(vide CBSE affiliation no. 530056)
E-mail Id-
Sponsored By:
Sh. D.R. Memorial Bal Shiksha Vikas Society (Regd.)

Registration Form for Class XI / XII


Instruction: 1. Size of Images to be uploaded should be more than 500 KB and less than 2 MB.
2. School will communicate on the email provided by you for Communication.

Enquiry No.
Applying for Class*
Student Photo (JPG/PNG) (Max 2MB)*
Father Photo (JPG/PNG) (Max 2MB)
Mother Photo (JPG/PNG) (Max 2MB)
Student First Name*
Student Middle Name
Student last Name*
Date of Birth
Date of Birth (In Words)*
Birth Certificate of Child (JPG/PNG) (Max 2MB)
Current Address Proof (JPG/PNG) (Max 2MB)*
Student Aadhar No.
Email for Communication*
Present Address
Sector/Locality/Apartments* City* State* Pin* Country* Tel No. (Landline)*
Permanent Address
Sector/Locality/Apartments* City* State* Pin* Country*
Father Name*
Mother Name*
Father Mobile No.*
Mother Mobile No.*
Father Aadhar No*
Mother Aadhar No*
Father Qualification
Mother Qualification
Father Occupation
Mother Occupation
Father Designation
Mother Designation
Father Office Address
Mother Office Address
Father Office Tel No.
Mother Office Tel No.
Email Id (Father)*
Email Id (Mother)
Name of the School last attended*
Affiliated to Board*
Identity Proof of Parents (JPG/PNG) (Max 2MB) :*
Board Marksheet / Mid term1 board Marksheet of Class X (JPG/PNG) (Max 2MB) :
CBSE Registration details from last School (JPG/PNG) (Max 2MB) :
Class X Marks Obtained*
Percentage (%) of marks*

Please select preference of stream and optional subjects from list below

Stream Preference* Subjects Available* Optional Subject 1* Optional Subject 2*

Please enter marks obtained in Class X

Subject English* Science* Maths* Social Science*
Marks Obtained
Total of ESM
(English, Science & Maths)
Percentage (%) of ESM
Total of ESM
(English, S. St. & Maths)
Percentage (%) of ESM
Sports Events at District Level
Sports Events at State Level
Sports Events at National Level
Literary Events
Cultural Events
Fine Arts
Any Other Events
Enter Remarks(If Any)

Attached photocopies of Marks Statement and certificate copies of co-curricular activities (If Any)

Marks Statement
(JPG/PNG) (Max 2MB)
Co-Curricular Certificate (JPG/PNG) (Max 2MB) Co-Curricular Certificate (JPG/PNG) (Max 2MB) Co-Curricular Certificate (JPG/PNG) (Max 2MB) Co-Curricular Certificate (JPG/PNG) (Max 2MB)

Details of Siblings in Blue Bells Model School (If Any)

Sibling Admission No. Student Name Class
First Sibling
Second Sibling

Alumni Details (If Any)

Alumni Name
Relation with the child
Passing out Class
Passing out Year
From Year
To Year
I hereby declare that the information furnished above is complete and correct to the best of my knowledge.