Jadavpur University Day Care Centre Application Form For printable pdf download

Jadavpur University Day Care Centre Application Form For

A recent

photograph of

the ward

JADAVPUR UNIVERSITY DAY CARE CENTRE

Application form for admission

1. Name and address of the applicant (in block letters): __________________________________________

_____________________________________________________________________________________

*2. Applicant’s nature of affiliation with Jadavpur University (designation, department/section):

_____________________________________________________________________________________

3. Relationship of the applicant with the ward: ________________________________________________

4. Name and address of the ward (in block letters): _____________________________________________

_____________________________________________________________________________________

**5. Sex and date of birth of the ward: ______________________________________________________

6. Whether the ward will need to be bathed at the Centre: Yes/No

7. Any relevant information about the ward: __________________________________________________

_____________________________________________________________________________________

8. Address for Communication: ____________________________________________________________

_____________________________________________________________________________________

9. Phone No._________________ Mobile No._________________ email:

I promise to abide by the rules of Jadavpur University Day Care Centre.

Date: ____________

Signature of the applicant in full

Enclosures: *One attested photocopy of the applicant’s university identity card or any such proof

**One attested photocopy of the ward’s birth certificate

Jadavpur University Day Care Centre Application Form For