Fairmount Daycare Mahim

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Application Form

CHILD'S INFORMATION

Date of application*

First Name*

Middle Name

Last Name*

Gender*

Date of Birth*

Age*

Religion*

Caste*

Sub Caste*

Current Address*

Pincode*

PRESENT CENTER INFORMATION ( If Applicable )

Name of Present Center

Center Contact No

Center Timings

PARENT / GUARDIAN DETAILS

Name*

Relation*

Contact Number*

Email Address*

Occupation*

Name of Employer

Work Address(if applicable)

Name*

Relation*

Contact Number*

Email Address*

Occupation*

Name of Employer

Work Address(if applicable)

MEDICAL INFORMATION ABOUT THE CHILD

List any existing medical conditions, medication or any special attention your child requires

Allergies*

Physician’s Name*

Contact Number*

In case of emergencies, the center may call the family physician or any other available physician to examine my child
YesNo

HEALTH INFORMATION

Please download our form and fill all the details correctly and upload this form bellow.

Download Form

Upload Form*

(pdf/png/jpeg/jpg max 5mb Allowed)

I agree not to hold Fairmount Daycare responsible for any possible illness, accident or injury caused on the center premises.

Seeking Admission for*

We confirm the above data for the purpose of admitting our child for the daycare services with Fairmount Daycare. We understand that the admission for daycare services does not in anyway confirm admission nor assure admission into the Fairmount Academy / Center.

DECLARATION

We confirm that each part of the application and the information inserted herein has been read carefully and is true and correct

Mother’s sign*

(pdf/png/jpeg/jpg max 5mb Allowed)

Father’s sign*

(pdf/png/jpeg/jpg max 5mb Allowed)

I hereby verify that I have read, understood and accepted all the above rules of the center.

(upload your signature in acceptance of the above undertaking)*