form

1. FORM NO. :
ADMISSION FORM
1 ADMISSION FOR : BABYSITTING
2 ) NAME OF THE CHILD :
3 ) SEX : MALE ( ) / FEMALE ( )
4 ) BIRTH DATE : BIRTH PLACE :
5 ) RESIDENTIAL ADDRESS :
6 ) PHONE NO. (R) :
7 ) ANY ADDITIONAL PHONE NO. :
8 ) FATHER'S NAME :
9) EDUCATIONAL QUALIFICATION :
10) OCCUPATION :
11) OFFICE / BUSINESS ADDRESS :
12) PHONE NUMBERS
* MOBILE :
* OFFICE (GIVE EXTENSION NUMBER ALS:O)
13) e-mail :
14) MOTHER'S NAME :
15) EDUCATIONAL QUALIFICATION :
16) OCCUPATION :
17) OFFICE / BUSINESS ADDRESS :
18) PHONE NUMBERS
* MOBILE :
* OFFICE (GIVE EXTENSION NUMBER ALS:O)
19) e-mail :
20) TIMINGS FOR BABY SITTING : FROM TO
PARENTS AGREE TO ABIDE ALL THE TERMS & CONDITIONS
SIGNATURE OF PARENT :
DATE :
G-1, VEDANT FLATS, NEAR SINDHU SEWA SAMITI SCHOOL,
ANAND MAHAL ROAD, ADAJAN, SURAT. PH. NO. : 2730967
www.killol.co.in sheetal@killol.co.in
BS040308