Hetauda Academy

Student's Name (IN BLOCK LETTERS)

• First Name
• Middle Name
• Last Name

Date of Birth

• Nepali Date (BS)
• English Date (AD)
• Gender
  Male     Female

• Address
• Admission for Grade Select Class Pre-Nursery Nursery LKG UKG 1 (One) 2 (Two) 3 (Three) 4 (Four) 5 (Five) 6 (Six) 7 (Seven) 8 (Eight) 9 (Nine) 10 (Ten) XI XII Bachelor

Local Guardian/Contact Person

• Full Name
• Relation
• Mobile No.
• Phone No.(Office)
• Email
• Occupation

Please tick (✓) the appropriate box if the student needs any/all the following services (optional).

• Hostel

  Yes No

  Lunch (Day Scholar)

  Yes No

• Bus

  Yes No

  Pick Up Point

Any particular disease(s)/illness(es) student is suffering from? If yes, please give details.

Does the student have any allergy? Is he/she under any medication? If yes, please give details.