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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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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