#291/4b, springdale avenue, punjai puliampatti, erode...
TRANSCRIPT
#291/4B, Springdale Avenue, Punjai Puliampatti, Erode District - 638 459.
PERMISSION FORM :
YEAR : ________________
NAME : ________________
GRADE : _______________
CHILD PICK – UP :
This information is extremely important WE WILL NOT release the Child to
any person other than those listed below with an Identity Card.
The following individuals are authorized to pick up my child. Same as above at
the end of the school day.
Name:
1. ____________ 2. ____________ 3. ____________ 4. ____________
Relationship:
1. ____________ 2. ____________ 3. ____________ 4. ____________
Phone No:
1. ____________ 2. ____________ 3. ____________ 4. ____________
(Please provide a specimen signature and phone number of the authorized person,
below their Photo. Also intimate the School in writing if the list needs to be changed
at any time)
Student Photo
PERSONAL HEALTH RECORD
Name : __________________________ Student ID : ______________
Date of Birth : ____________ Gender: Boy/Girl Grade : ______________
Blood Group : ____________ Height: _______ Weight : ______________
1. Specific Health Concerns that the school has to be aware of:
__________________________________________________________________________
2. Allergies if any: __________________________________________________________
3. Immunization record:
Date of VaccinationDate of Vaccination
Vaccines
BCG/DPT/POLIO
Hepatitis A
Hepatitis B
Chickenpox
HIB Vaccines
Measles
MMR
DPT Booster
Typhoid
4. Child’s Doctor : ____________________ Contact No : ________________
Address : ________________________________________________________
In the event of an emergency and parent is not available, please call the following who have
my permission to come and take child home from school
Name : _____________________________ Relationship : ___________________
Telephone : __________________________ Cellular : ___________________
Address : __________________________________________________________________
In the event I cannot be reached, I give consent for medical emergency treatment for my child
for which I will be financially responsible.
Date : ______________________________ Signature of Parent : ________________
TRANSPORTATION SLIP
SCHOOL YEAR : __________________
NAME : _____________________
GRADE : _____________________
ID NO : _____________________
We agree to send the child by school transport to and from the residence
address given below in accordance with fees and terms proposed by the school.
NAME & ADDRESS :
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
PHONE NUMBER :
Father : __________________________ Mother : _____________________
Alternative No : ___________________ Date : _____________________
Signature : _______________________
LOCATION MAP OF RESIDENCE:
Student Photo