PRABHAT MEMORIAL HIGH SCHOOL

Nepalgunj-10, Bhrikutinagar, Banke, Lumbini Province 081-590117, 590118, 9858039117

Online Registration Form

Student Name (IN BLOCK LETTERS)

First Name
Middle Name
Last Name
Date of Birth (A.D)
Date of Birth (B.S)
Gender
Male Female
Nationality
Ethnicity
Religion
Mother Tongue
Language Spoken at Home

Permanent Address
Temporary Address
Personal Interest & Hobby

Medical Information

Blood Group
Allergies
Differently able
Yes No
Any Other Health Problems
Admission Sought to Class
Passed Class/Level

School History (Most recent school first)

S.N	School	Class	Duration(Year)
1.
2.
3.

Father's Information

Full Name
Occupation
Contact No.
Email

Mother's Information

Full Name
Occupation
Contact No.
Email

Local Guardian/Contact Person

(An emergency number to be used if the parents are unreachable)

Full Name
Relation
Contact No.

Other Children in the family

Full Name
Age
Grade
School

Student's Image

(Note: Only jpg/jpeg/png/pdf. Max size 3 MB.)

Birth Certificate

(Note: Only jpg/jpeg/png/pdf. Max size 3 MB.)

Mark-sheet

(Note: Only jpg/jpeg/png/pdf. Max size 3 MB.)

Does your child need to be picked up by school?

Yes No
If Yes Nearest Bus Stop:

Does your child need school meal?

Yes No
If Yes please mention food habit:
Vegetarian Non-Vegetarian

Please mention if you have any special remarks?