Jeeyar Educational Trust :: Prajna Summer Camp 2017
REGISTRATION FORM FOR CHILDREN
(Registration Fee - Rs.500)
Name
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Date of Birth
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DD
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School Name
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Class
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Residential Address
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Mother's Name
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Mother's Phone Number
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Mother's Email Address
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Father's Name
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Father's Phone Number
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Father's Email Address
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Allergies / Health Conditions
if any
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Medication
if any
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Voluntary Donation
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Specify donation amount
if any
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How did you hear about us?
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