REGISTRATION FORM

for

   Events of Science Park

 

 

     Important Instruction :
1.Please fill the information correctly.
2.Admissions are on the First come first serve basis.
3.Registrations are open till the last date or till the batch gets full.
4. Sessions will be conducted in English/Marathi/Hindi.
    
*** Once you  fill the following information, you will be able to register your kid/s for coming Camps  or Sessions
 
Please fill in the following form carefully and press the "Submit" button.
* marked fields are COMPULSORY
Incomplete registrations will NOT be entertained.
 
 

 # Details :
 Your email Id

*

  
  # This email id will be your USERNAME for this system. In future, all the emails from Science Park will be sent to this email id only.
 Enter the Password

*

  
 Re-Enter the Password

*

  
  
 

          

 

         

 

           Mother's Details:

 

          Father's Details :

Mother's Name    :  Father's Name    : 
Contact No    :  Contact No    : 
Email Id    :  Email Id    : 
Occupation    :  Occupation    : 
 
 
 Your Residential Address : *Address 1:
   *Address 2:
   *        City : 
   *   Pincode :
 
 # Student's Details :
 
 Name of the Student

*
   Surname    First Name    Middle Name
 Date Of Birth : *   (in DD-MM-YYYY format)        
 Gender : *           
 School Name :  
 School Address :

*
 Standard Completed:
(In May 2020)

*
 Medium:

*

           
 
  Does your child suffer from any kind of allergies, illness, disability, phobia or other Medical conditions? If yes, Please specify
 Allergy Info : (If Any)
 
  If you have your own second  child who is also interested to join the Science Camps or Hands on training, please furnish his/her info.
 
 Second child interested joining the Camps?

*

             
 
 # Additional Details
 
 Has the student attended Science Park course before? :  
 From where you got the  info. about these courses? :