Addmission Form

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The Scholars' Hub

Academic — tutoring Gen-Next

SL. No.

Student's Photo Click to upload

1st

Parent's Photo With Student — Click to upload

2nd

Admission Form

Student Information

First Name * First name is required

Middle Name

Last Name * Last name is required

Father's / Guardian's Name * This field is required

Occupation

Mother's Name

Date of Birth * Date of birth is required

Gender * Select Male Female Other Please select gender

Blood Group Select A+ A- B+ B- AB+ AB- O+ O-

Permanent Residence Address

Address Line * Address is required

City * City is required

State * State is required

Pin Code * Valid 6-digit pin required

Phone (STD)

Phone (Number)

Mobile 1 * Valid 10-digit mobile required

Mobile 2

Email (Parent's Email ID) * Valid email is required

Address of Correspondence

Same as Permanent Residence Address

Address Line

City

State

Pin Code

Phone

Mobile 1

Mobile 2

Declaration

Guardian Name * Name is required

Address * Address is required

Mobile No * Valid mobile required

Relationship with Student * Relationship is required

Date * Date is required

Place * Place is required

Student / Guardian Signature

Parent / Guardian Signature

Office Use

Cash / Cheque / DD No.

Amount (Rs.)

Drawn On

Registration

Office Receipt No.

Receipt Date

Preview Your Application

Please review all details before final submission

No photo uploaded

Student's Photo

No photo uploaded

Parent's Photo with Student

Student Information

Serial No	-
Full Name	-
Father/Guardian	-
Occupation	-
Mother's Name	-
Date of Birth	-
Gender	-
Blood Group	-

Permanent Address

Address	-
City / State / Pin	-
Phone	-
Mobile 1	-
Mobile 2	-
Email	-

Correspondence Address

Same as Permanent	-
Address	-
City / State / Pin	-
Phone / Mobile	-

Declaration

Guardian Name	-
Address	-
Mobile	-
Relationship	-
Date & Place	-

Signatures

Student / Guardian

Parent / Guardian

Office Use

Payment Ref	-
Amount	-
Drawn On	-
Registration	-
Receipt No / Date	-

✓

Application Submitted!

Your admission form has been successfully submitted and emailed to pikubhai011@gmail.com.

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