Please affix a

THE RAJKUMAR COLLEGE, RAJKOT recent coloured

REGISTRATION FORM photograph of the
[FILL IN BLOCK LETTERS PLEASE] child.

We ____________________________ and _______________________________ desire to have our son /

daughter / ward whose particulars are given below admitted as a Boarder Day Scholar Towner

INFORMATION OF CHILD
First Name Father’s Name Surname

Date of Birth Place of Birth (City/Village; Dist.; State; Country)

Religion Caste Mother Tongue Nationality

Do you belong to SC / ST / OBC ? : _______ (Yes / No)

(If yes, please attach an attested certificate from an appropriate authority)

Aadhar Number of the Student:_______________________________________________________________

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

Pin code: Pin code:

TELEPHONE NUMBERS
Area Code : Office : Residence :
Fax : Father’s Mobile : Mother’s Mobile :
Guardian’s Off: Res: Mobile:
Email :
Name and addresses of two local guardians, if any, who may take the child out on leave:

Name : _____________________________ Name : ___________________________

Address : _____________________________ Address : ___________________________
_____________________________ ___________________________
_____________________________ ___________________________
Phone:Off: _____________________________ Phone :Off: ___________________________
Res: _____________________________ Res: ___________________________
Mobile _____________________________ Mobile ___________________________

Dietary Preference : Vegetarian Non-vegetarian Eggs

--------------------------------------------------------------------------------------------------------------------------------------
Prospectus & Registration Fee : Rs. 5000/- NON-REFUNDABLE.
Received cash / D.D./ cheque no. ___________ dated _________ drawn on __________________________
for Rs. ____________________ as Prospectus & Registration Fee vide Receipt No._____________ .
FAMILY INFORMATION

Father / Guardian Mother / Guardian

Name : Name :
Educational Qualification : Educational Qualification :
Medium of Education : Medium of Education :
Occupation : Occupation :

Annual income of the family : Rs. _______________

(Required as per the rules of CBSE, New Delhi)

No. of siblings of this student : _______

Is / was any real brother or sister of this student studying at RkC? : _______ (Yes / No)
If yes, please mention the name below:

1.__________________________________________

2.__________________________________________

3.__________________________________________

Is this student son / daughter / grandson / granddaughter of an Old RkCian? : _______ (Yes / No)
If yes, please mention the name below:

1.__________________________________________

2.__________________________________________

3.__________________________________________

Is this student son / daughter / grandson / granddaughter of a staff member? : _______ (Yes / No)
If yes, please mention the name below:

1.__________________________________________

2.__________________________________________

3.__________________________________________

Is this student from or related to Founding members of the RkC? : _______ (Yes / No)
If yes, please mention the name below:

1.__________________________________________

2.__________________________________________

3.__________________________________________
PREVIOUS SCHOOL ATTENDED, IF ANY
Name :
Address :
Affiliated to (Board) :
Medium of Instruction :
Class presently studying in : Academic year :
Certified copies of Mark Sheets of current & previous years to be attached. Original Mark Sheets to be
submitted also for verification.

MEDICAL
Nature of serious illness, if any:
Physical weakness, if any, which requires special attention / observation :

Medical Form to be filled in at the time of admission.

PROOF OF AGE
We solemnly declare that the date of birth of the child given above is as per the Birth Certificate which is
produced for verification. A certified copy is also enclosed.

SIGNATURES
We hereby certify that the information given here is complete and accurate. We understand and agree that
misrepresentation or omission of facts will justify the denial / cancellation of admission, or dismissal from
school.

We have read the College prospectus and its General Rules & Discipline and bind ourselves to submit to
College rules as changed from time to time, in all respects.

We understand that registration does not in any way guarantee admission.

_________________________________ ______________________________
Signature of Father / Guardian Signature of Mother / Guardian
Date : Date :

*********

FOR SCHOOL OFFICE RECORD ONLY

 Registered for Class _______ for year ______________as Boarder / Day Scholar / Towner

Date: _________________ Admission Officer :______________________

NOTE: Entrance Examination / Interview date will be intimated later.

 FOR OFFICE USE ONLY

Check list:

School Leaving Certificate (original) Class

Medical Form Lodge

Declaration House

DD/ Cheque for School Fee Date of Birth

Birth Certificate, if pending Agerol No.

Mark Sheets, if pending

Caste Certificate

Aadhar Card

Date: _______________ Registry Officer _____________________

 THE RAJKUMAR COLLEGE, RAJKOT

DECLARATION

I, Father/ Mother/ Guardian of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ hereby

declare and agree to the following:

1. It is understood that all the students of The Rajkumar College, Rajkot, are strictly forbidden from smoking
of cigarettes or possession of cigarettes / tobacco products, use of drugs or possession of drugs, and
possession of unauthorized cash, and that the school reserves the right to expel my ward any time including
the final external examination period if he / she is found guilty of any such offence.
2. It is further understood that the school reserves the right to expel my ward any time including the final
external examination period for indulging in any act of misconduct / indiscipline involving any other pupils.
3. The school will not be held responsible for any injury suffered by my ward or for his / her loss of life
during activities such as games, sports, gymnastics, swimming, excursions, and travelling.
4. I hereby give my consent for any emergency surgery, if necessary, to be performed on my ward and declare
that the school authorities will not be held responsible for any adverse consequences thereof.
5. The school reserves the right to strike the name of my ward off the Roll or stop him / her from appearing
for any examinations including external examination for non – payment of fees and other dues before the
commencement of such examinations.
6. The school will not undertake to make the travel arrangements of my ward if the requisition for the same is
made after the date stipulated in the school circulars.
7. I hereby give my consent that my ward may go on any excursion organized by the school outside the
campus and my prior consent is required only in case the cost of the proposed trip is likely to exceed
Rs.1500/-.
8. No change in the status of a student i.e. Boarder to Towner / Day Scholar or Towner to Day Scholar
will be permitted under any circumstances. I also understand that if I wish to change my ward’s
status at any time, I will have to withdraw my child/ward and seek re admission as per the procedure
for admission.

_____________________ ____________________________________
Place Signature of Father / Mother / Guardian

_____________________ ____________________________________
Date Name of Father / Mother / Guardian
 THE RAJKUMAR COLLEGE, RAJKOT
RULES FOR PAYMENT OF FEES

ONCE FEE IS DEPOSITED, IT IS NON-REFUNDABLE UNDER ANY CIRCUMSTANCES.

Annual School Fee is payable in four installments due on 1st April, 1st July, 1st October and 1st January of each
academic year.

The School does not take the responsibility of sending reminders to parents to pay School dues.
The dates for the payment of the fee are firm.

In case the fee is not paid within stipulated time, Rs. 100 per day will be charged as surcharge for which a
month’s grace will be given.

Even after that date if the fee is not paid Rs. 200 per day will be charged as fine for another month.

After the expiry of two months the student will be sent back home without any prior notice with an escort, and
his/her name will be struck off from our General Register, and if he/she is to be re-admitted, it will be treated as
a fresh admission and all the formalities needed for a fresh admission will be applicable in that case.

No student will be permitted to sit for any examination unless his fee dues are cleared in full.

Financial considerations leave the school with no option but to treat a student whose dues are not cleared within
the stipulated time as withdrawn without notice.

PROCEDURE FOR WITHDRAWAL

FIRST TERM :

No notice fee will be charged if parents wishing to withdraw their child from the school send a written
intimation by 31st March

Rs. 2500/- will be charged as notice fee if the intimation is sent after 31st March until 30th April.

After 30th April until 15th May, half the fees of the term will be charged as notice fee.

Full fee of the term will be payable if a child is withdrawn after the 15th May.

SECOND TERM :

No notice fee will be charged if parents wishing to withdraw their child from the school send a written
intimation by 30th September.

After 30th September until 31st October, half the fees of the term will be charged as notice fee.

Full fee of the term will be payable if a child is withdrawn after the 31st October.

_______________ ____________________________
Date Signature of Parent / Guardian
 THE RAJKUMAR COLLEGE, RAJKOT
PUPIL INFORMATION FOR LODGE / INCHARGE
[ FILL IN BLOCK LETTERS PLEASE ]

Name: _________________________________________________________

Name of the Father / Guardian : _____________________________________

Name of the Mother / Guardian : _____________________________________ Please affix a

recent coloured
Current Address: ______________________________________________ photograph of the
______________________________________________ child.

______________________________________________

Telephone: Off. ______________________________________________

Res. ______________________________________________

Mobile ______________________________________________

Name and addresses of two local guardians, if any, who may take the child out on leave:

Name : _______________________________ Name : ________________________________

Address : _______________________________ Address : _________________________________
_______________________________ _________________________________
_______________________________ _________________________________
Phone:Off: _______________________________ Phone :Off: _________________________________
Res: _______________________________ Res: _________________________________
Mobile: _______________________________ Mobile: ________________________________

Dietary Preference: Vegetarian Non-vegetarian Eggs

Date of Birth Place of Birth (City/Village; Dist.; State; Country)

Religion Caste Mother Tongue Nationality

MEDICAL
Nature of serious illness, if any:
Physical weakness, if any, which requires special attention / observation :

_________________________________ ______________________________
Signature of Father / Guardian Signature of Mother / Guardian
Date : Date :
 THE RAJKUMAR COLLEGE, RAJKOT
MEDICAL EXAMINATION FORM

A. INTRODUCTORY:
Name:__________________________________________________________________________ Age:___________
Birth Date:____________________________ Height:_______________________ Weight:_____________________
B. GENERAL:
Eye: (including vision) ________________________________________________________________
Ear: ________________________________________________________________
Nose: ________________________________________________________________
Throat: ________________________________________________________________
Tongue: ________________________________________________________________
Teeth: ________________________________________________________________
Nails: ________________________________________________________________
Skin: ________________________________________________________________
Body Build: ________________________________________________________________
C. SYSTEMIC:
Cardiovascular: ________________________________________________________________
Respiratory: ________________________________________________________________
Digestive: ________________________________________________________________
Nervous: ________________________________________________________________
Excretory: ________________________________________________________________
Bones & Joints: ________________________________________________________________
D. PAST HISTORY, IF ANY, WITH PARTICULARS:
___________________________________________________________________________________________

E. BLOOD GROUP: ________________________________________________________________

F. FAMILY HISTORY:
Hypertension: ________________________________________________________________
Diabetes: ________________________________________________________________
Bronchial Asthma: ________________________________________________________________
Allergic manifestations: ________________________________________________________________
G. VACCINATIONS:
Primary Vaccinations: ________________________________________________________________
T.A..B. ________________________________________________________________
Hepatitis B: ________________________________________________________________
H. SENSITIVITY TO ANY DRUG: ________________________________________________________________
I. REMARKS: ________________________________________________________________
___________________________________________________________________________________________

*(Stamp & Signature of the Family Physician)

Date:_______________________ Registration No.:______________________
SCHOOL FEE STRUCTURE

* Prospectus & Registration Fee: non-refundable; payable at the time of registering at the School.

* Admission Fee: non-refundable; payable at the time of admission.

* Facilities Charges: non-refundable; payable at the time of admission.

* Caution Money: refundable without interest at the time of leaving the School after clearing all dues, if any.

* Imprest Deposit: accountable; covers cost of issues from School stores, text books, games tours, educational
visits and other personal miscellaneous expenses. A statement of account will be sent along with the fee
memo and parents are expected to maintain the balance at the stipulated level. Balance refundable at the time
of leaving after settling all dues.

NOTE: Travelling money for vacations should be paid separately well before commencement of each
vacation.

* Initial Kit Payment: payable once at the time of admission to cover the cost of initial kit as listed. Any
excess balance will be credited to the Imprest Deposit account. A statement of expenses incurred will be sent.

* PSC Scholarship Trust: a one-time contribution from all new admissions towards the Public Schools’
Conference Trust.

* Pocket Money: Payable annually in four installments along with the School Fee.

* Annual School Fee: Payable in four installments due on 1st April, 1st July, 1st October and 1st January of
each academic year.
Annual School fee covers cost of Tuition, Computer Education, Library, facilities charges, co-curricular
activities, board and lodging, bedding (except blankets and quilts), washing, hair-cut and basic medical &
games facilities and stationery for Boarders and Towners.

NOTE: At the time of leaving the School, every student is expected to contribute Rs.2000/- towards the
Rajkumar College Old Rkcians Association of which he/she becomes a life member.

RULES FOR PAYMENT OF FEES:

ONCE FEE IS DEPOSITED, IT IS NON-REFUNDABLE UNDER ANY CIRCUMSTANCES.

Annual School Fee is payable in four installments due on 1st April, 1st July, 1st October and 1st January of each
academic year.

The School does not take the responsibility of sending reminders to parents to pay School dues. The
dates for the payment of the fee are firm.

In case the fee is not paid within stipulated time, Rs. 100 per day will be charged as surcharge.

After the expiry of two months the student will be sent back home without any prior notice with an escort, and
his/her name will be struck off from our General Register, and if he/she is to be re-admitted, it will be treated as
a fresh admission and all the formalities needed for a fresh admission will be applicable in that case.

No student will be permitted to sit for any examination unless his fee dues are cleared in full.

Financial considerations leave the school with no option but to treat a student whose dues are not cleared within
the stipulated time as withdrawn without notice.
PROCEDURE FOR WITHDRAWAL

FIRST TERM :

No notice fee will be charged if parents wishing to withdraw their child from the school send a written
intimation by 31st March

Rs. 2500/- will be charged as notice fee if the intimation is sent after 31st March until 30th April.

After 30th April until 15th May, half the fees of the term will be charged as notice fee.

Full fee of the term will be payable if a child is withdrawn after the 15th May.

SECOND TERM :

No notice fee will be charged if parents wishing to withdraw their child from the school send a written
intimation by 30th September.

After 30th September until 31st October, half the fees of the term will be charged as notice fee.

Full fee of the term will be payable if a child is withdrawn after the 31st October.