ELC Registration form
Child's Full Name *
Your answer
Child's Gender *
Date of Birth *
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DD
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YYYY
Name the child Prefers to be called *
Your answer
Language of Child's Preference *
Your answer
Phone number for communication *
Your answer
Email address for communication *
Your answer
Program Applied for *
Mother's/Guardian's Full Name *
Your answer
Mother's Age
Your answer
Home Address *
Your answer
Mothers Education Qualification *
Your answer
Mother's Occupation *
Your answer
Mothers Work Address *
Your answer
Mothers Mobile Number *
Your answer
Home Number *
Your answer
Mother's Email Address *
Your answer
Marital Status *
Father's Full Name *
Your answer
Fathers Age
Your answer
Father's Education Qualification *
Your answer
Fathers Occupation *
Your answer
Fathers Work Address *
Your answer
Fathers Mobile Number *
Your answer
Fathers Home Number *
Your answer
Fathers Email address *
Your answer
Does your child have any existing Medical conditions, medications or requires any special attention regarding health? *
Your answer
Allergies if any: *
Your answer
Child's Pediatrician's Name *
Your answer
Child's Pediatrician's Number *
Your answer
Child's Pediatricians Address *
Your answer
Child's Blood Group *
Does the child have special needs? if Yes, please elaborate *
Your answer
Have you taken the child to a psychiatrist, speech therapist, occupational therapist, physiotherapist, psychologist or any special educator? If yes, please state the purpose. *
Your answer
Please write a few words about your child that may help us get to know him/her better ( for e.g Aptitude/Temperament/hobbies/personality ) *
Your answer
Please let us know your child’s favorite song, story or activity that will help us during the initial transition time *
Your answer
Suggestion or Information: Do you have any suggestions or comments? *
Your answer
Where you satisfied with the orientation about ELC that you got ? could the process be improved *
Your answer
How did you hear/find out about ELC? *
Your answer
Kindly submit Email of the child's birth certificate & three photos to teachers@elcindia.org
By submitting this application, I aware that ELC is a private organization and all rights of admission are reserved.I hereby apply for my child’s registration at Early Learning Centre for the academic year2018- 19. I have been informed about the philosophy, guidelines, fee structure and other relevant information.
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