Pre Admission Form – St. Xaviers' English High School & Jr. College

Name of the Child

Father's Name

Surname

Mother's Name

Present Address

Address Line 1

City

State / Province / Region

Postal Code

Tel. No.

Mobile

Class to which is admission is required:

Name of the last school attended :

Date of Birth : (In word)

Mother Tongue :

Father's Qualification :

Father's Mobile No.:

Occupation:

Designation:

Annual Income:

Address

Address Line 1

City

State / Province / Region

Postal Code

Mother's Qualification:

Mother's Mobile No.:

Occupation:

Designation:

Annual Income:

Office Address:

Address Line 1

City

State / Province / Region

Postal Code

Name :

Std:

Div:

Medical condition (Allergic etc.)if any :

Please submit a copy of the medical certificate. This will ensure timely action in case of any emergency.

Transportation Required

Bus Stop