DRISHTI - Day Care with Survival Education for Children with Learning Disability

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ADMISSION FORM
(Please fill up all the form given below)

Candidate's Details

Full Name:

Date of Birth:

Disability Type:

Percentage of Disability:

Aadhar No:

Gender:

Category:

Previous School:

Specific Learning Difficulty:

Guardian's Details

Guardian Name:

Guardian Occupation:

Guardian Income:

Email ID:

Contact No.:

Address:

City:

State:

Pin:

Parent's Details

Fatrher's Name:

Mother's Name:

Diagnosed As:

Scanned Copy of Documents

Date of Admission:

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