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Child Information

First Name
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Last Name

Class
Select Class Infant Toddler PreNursery Nursery KG I II III IV
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Section

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Date of Birth

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Gender
MaleFemale You can't leave this empty

School Name

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Blood Group
Select Blood Group A+ A- B+ B- O+ O- AB+ AB-
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Residential Address

Address Line 1
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Address Line 2

City

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State
Select State Andaman and Nicobar (UT) Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh (UT) Chhattisgarh Dadra and Nagar Haveli (UT) Daman and Diu (UT) Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep (UT) Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry (UT) Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal
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Pin

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Phone
+ 91 -
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Mobile
+ 91 -
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E-mail

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Allergies to Medicine and Food

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Birth History Complication /History of Major illness, if any:

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Immunization Status(Attach photocopy of Immunization card)

BCG

Measles

OPV

MMR

OPT

Typhoid

Booster for OPV

Hepatitis B

Booster for DPT

Any Other

ADAC Centre
Select ADAC Centre Noida Gurgaon You can't leave this empty