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Registration

Course Detail

Course *

Stream *

Test Package *

Student Detail

FIRST NAME * {{ errors.first('firstName') }}

MIDDLE NAME * {{ errors.first('middleName') }}

Last NAME * {{ errors.first('lastName') }}

EMAIL ADDRESS * {{ errors.first('email') }}

MOBILE ADDRESS * {{ errors.first('mobile') }}

DATE OF BIRTH *

CATEGORY * {{ errors.first('category') }}

CASTE * {{ errors.first('caste') }}

RELIGION * {{ errors.first('religion') }}

NATIONALITY * {{ errors.first('nationality') }}

GENDER *

AADHAR NUMBER * {{ errors.first('aadharNumber') }}

PERSONAL PHOTO *

SIGNATURE PHOTO *

BLOOD GROUP *

MOTHER TONGUE * {{ errors.first('motherTongue') }}

LANGUAGE KNOWN * {{ errors.first('languageKnown') }}

URBAN or RURAL *

DISTANCE FORM SCHOOL * {{ errors.first('distanceFromSchool') }}

Correspondence Address

Address * {{ errors.first('Correspondance Address') }}

Land Mark * {{ errors.first('landmark') }}

City * {{ errors.first('city') }}

State * {{ errors.first('state') }}

Postal Code * {{ errors.first('pincode') }}

Permanent Address

Same as correspondence address

Address *

Land Mark *

City *

State *

Postal Code *

Father's Details

NAME * {{ errors.first('fatherName') }}

AGE * {{ errors.first('fatherAge') }}

EMAIL ADDRESS * {{ errors.first('fatherEmail') }}

MOBILE NO. * {{ errors.first('fatherMobile') }}

QUALIFICATION * {{ errors.first('fatherQualification') }}

OCCUPATION * {{ errors.first('fatherOccupation') }}

DESIGNATION * {{ errors.first('fatherDesignation') }}

PHOTO *

NATIONALITY * {{ errors.first('fatherNationality') }}

AADHAR NUMBER * {{ errors.first('fatherAadharNumber') }}

ANNUAL INCOME * {{ errors.first('fatherAnnualIncome') }}

OFFICE Address *

Mother's Details

NAME * {{ errors.first('motherName') }}

AGE * {{ errors.first('motherAge') }}

EMAIL ADDRESS * {{ errors.first('motherEmail') }}

MOBILE NO. * {{ errors.first('motherMobile') }}

QUALIFICATION * {{ errors.first('motherQualification') }}

OCCUPATION * {{ errors.first('motherOccupation') }}

DESIGNATION * {{ errors.first('motherDesignation') }}

PHOTO *

NATIONALITY * {{ errors.first('motherNationality') }}

AADHAR NUMBER * {{ errors.first('motherAadharNumber') }}

ANNUAL INCOME * {{ errors.first('motherAnnualIncome') }}

OFFICE Address *

Siblings's Details

NAME * {{ errors.first('siblingName') }}

AGE * {{ errors.first('siblingAge') }}

INSTITUTE * {{ errors.first('siblingInstitute') }}

STANDARD * {{ errors.first('siblingStandard') }}

Medical History

Birth History

BIRTH DETAILS * {{ errors.first('birthDetail') }}

BIRTH CRY * {{ errors.first('birthCry') }}

DISCHARGE FROM HOSPITAL IN DAYS * {{ errors.first('dischargeInDays') }}

SPECIAL CARE GIVEN IN HOSPITAL * {{ errors.first('specialCare') }}

NICU CARE GIVEN IN HOSPITAL * {{ errors.first('ifNICU') }}

Hearing

Hearing difficulty * {{ errors.first('hearingDifficulty') }}

Any Consultation with Doctor * {{ errors.first('hearingConsultation') }}

Vision History

Use of Spectacles/Corrective Lenses * {{ errors.first('visionUseLenses') }}

Any consultation with Doctor * {{ errors.first('visionConsultation') }}

Mile Stones

Sitting * {{ errors.first('sitting') }}

Standing * {{ errors.first('standing') }}

Walking * {{ errors.first('walking') }}

Speech * {{ errors.first('speech') }}

Any medication taken for any medical conditions * {{ errors.first('medicationForMedicalCondition') }}

Any Medication taken for general well being * {{ errors.first('medicationForWellBeing') }}

Any Medication taken for Alergy * {{ errors.first('medicationForalergy') }}

Miscellaneous

How did you hear about Institue? * {{ errors.first('howDidHearAboutInstitute') }}

Emergency Contact Details

Emergency Name * {{ errors.first('emergencyName') }}

Person Contact Number * {{ errors.first('emergencyMobile') }}

Relationship with Person * {{ errors.first('emergencyRelation') }}

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