Admission Form

Admission Form

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To,
The Principal
Dombivali(E)

Sir,
Kindly enroll my
in your class in Standard of Science .

Particulars are as follows

1. Full Name of the Student :
2. Full Name of the Parent/Guardian :
3. Residential Address :
4. Mobile No (F) : Mobile No (M) :
   Student Mobile No : Tel No :
5. Email Id of Student :
6. Email Id of Parent :
7. Aadhar No of Student :
8. 10th Marks : Total Marks % Mathematics /100 Science /100
9. Subjects Applied For :
10. Course Applied For :
11. Name of the School/College: :
12. College Timing: :

DECLARATION
I here by declare

1) that I am seeking admission in my own interest and accord.

2) that I shall be responsible for my rustication on grounds of my misconduct, misuse of mobile phones, misuse of internet or any illegal and indecent activity.

3) that in case of my selection in Medical/ Engineering Entrance Exams/ National/ International Olympiads/ NTSE/ KVPY/ Boards, the institute reserves the right to use my information for publicity.

4) that I solemnly affirm that I authorize Rege- Dixit Science Academy to send me emails, SMS alerts and post on the mentioned communication details.

5) I understand that in the event of any information found to be incorrect or false, my admission may get cancelled without any refund of fees.

6) that I have read all the available details with Application kit and I do agree to follow the instructions as applicable. I also agree to abide by the Refund Rules of the Institute.

7) that the fees are refundable only on the ground of transfer of parents or detention of in earlier standard.

8) that parking of bicycles would not obstruct the passage of others.