Under the Ages of School Games Federarion of India

KENDRIYA VIDYALAYA SANGATHAN (MUMBAI REGION)

NATIONAL SCHOOL GAMES 2018 TO 2019

UNDER THE AGES OF SCHOOL GAMES FEDERARION OF INDIA

CERTIFICATE OF ELIGIBILITY

Signature of student

UNDER- (BOYS/GIRLS) :- GAME/EVENT :-

1 / NAME OF THE PARTICIPANT
(In block letters)
2 / FATHER’S NAME(In block letters)
3 / MOTHER’S NAME(In block letters)
4 / NAME OF THE SCHOOL ( In block letters)
5 / FULL ADDRESS OFSCHOOL(In Block Letters)
6 / SCHOOL’S PHONE NO .WITH CODE NO.
7 / LAST YEAR REGISTRATION NO.SGFI
8 / DATE OF BIRTH (1)IN FIG
(2)IN WORDS / ---- / ----
9 / DISCIPLINE
10 / AADHAAR NO. No.
11 / PASS PORT NO.(IF Available)
12 / AGE IN COMPLETED YEARS
AS ON 31ST DECEMBER / YEAR MONTH DAYS
---- / ------
13 / PERMANENTADDRESS &PHONE & MOB NO:-(In block letters) / PHONE:- MOB:-
14 / ADMISSION NO &YEAR / NO: YEAR:-
15 / DATE OF JOINING THE SCHOOL
16 / STANDARD & SECTION STUDYING
THIS YEAR / STANDARD :- SECTION-
17 / STANDARD STUDYING LAST YEAR
18 / BANK DETAIL OF PARTICIPANT
(IF NO THEN MENTION MOTHER/FATHER A/C NO.)
19 / PERSONAL IDENTIFICATIONMARKS:-
20 / SIGNATURE OF THE PARTICIPANTS

CERTIFICATE:-1. Certified that above participant is a bonfire student of this institution for the academic year 2. Certified that I have personally verified the admission records maintained in the school and found correct 3. Certificate that it is understood in the event of information furnished above found to be partly or wholly untrue, the above student is liable to be disqualified for a period of two years in case The student is a member of team, then the participant is liable to be disqualifiedas a whole.

SIGNATURE OF COMPETENT AUTHORITY

KENDRIYA VIDYALYA SANGATHAN

SCHOOL STAMP:- CLASS TEACHER TGT (P&HE) PRINCIPAL WITH SEAL

SIGNATUR SIGNATURESIGNATURE

FOR OFFICE USE ONLY NAME OF INVGILATOR…………………..… SIGN OF INVIGILATOR……………

To

The Principal

Kendriya Vidyalaya,

……………..

NO OBJECTION CERTIFICATE

Sir/Madam,

I,……………………………………………………,Father / Mother of ...... of class …………….section …………..Hereby affirm that I have no objection to his/ her selection and outstation participation as mentioned above. I hereby agree to the conditions and give my consent to his/ her participation and further the selection for higher level if found eligible and I shall not withdraw in between. I shall instruct him/ her to strictly follow the instruction of the escorts and shall not hold KVS/ Teachers/ Escorts/ Asst. Contingent & Contingent Managers responsible for anything arising out of the failure of the students to follow the instructions.

Date : Signature of Parent with Full Name

Phone Number:

TRACKSUIT SIZE / KIT SIZE / SHOES SIZE / VEG /NON VEG / BLOOD GROUP / SIGN

…………………………………………………………………………

RISK CERTIFICATE

I, Mr/Mrs…………………………………………………………….. Have no objection and give consent for my wards Master/Kumari ………………………………. of class ……………section…………..for participating in KVS Regional/National/SGFI sports meet at my own risk and will not hold Kendriya Vidyalaya/ Escort Teachers Asst. Contingent & Contingent Managers responsible for any untoward incident.

Signature of StudentSignature of Parent

Place:Phone Number of Parent:

Date:

……………………………………………………………………………………………………………

Medical certificate

This is to certify that Master/Kumari ………………………..ofclass ………..section………. KendriyaVidyalaya ,……………………………………………………….. , has been medically examined by me.

He is not suffering from any disease. He/ She is fit to participate in Games & Sports/Athletics/Trekking/ Adventure activities.

Date:Signature of Medical Officer

With Seal.

PLACE- –––––––––––––Mob------