Under the Ages of School Games Federarion of India

KENDRIYA VIDYALAYA SANGATHAN (MUMBAI REGION)

NATIONAL SCHOOL GAMES 2015 TO 2016

UNDER THE AGES OF SCHOOL GAMES FEDERARION OF INDIA

CERTIFICATE OF ELIGIBILITY

Signature of student

UNDER-11/14/17/19 (BOYS/GIRLS) :- GAME/EVENT :-

1 / NAME OF THE PARTICIPANT
(in the block letters)
2 / FATHER’S NAME
(in the block letters)
3 / NAME OF THE INSTITUTION(in the block letters)
4 / INSTITUTION FULL ADDRESS
(in Block Letters)
5 / INSTITUTION PHONE NO .WITH CODE NO.
6 / LAST YEAR REGISTRATION NO.SGFI
7 / DATE OF BIRTH (1)IN FIG
(2)IN WORDS / ---- / ----
8 / DISCIPLINE
9 / PASS PORT NO.(IF Avallable)
10 / AGE IN COMPLETED YEARS
AS ON 31ST DECEMBER / YEAR MONTH DAYS
---- / ------
11 / HOME ADDRESS IN FULL
PHONE NO & MOB NO:-
(in the block letters) / PHONE:- MOB:-
12 / ADMISSION NO &YEAR / NO: YEAR:-
13 / DATE OF JOINING THE SCHOOL
14 / STANDARD & SECTION STUDYING
THIS YEAR / STANDARD :- SECTION-
15 / STANDARD STUDYING LAST YEAR
16 / PERSONAL IDENTIFICATIONMARKS:-
17 / SIGNATURE OF THE PARTICIPANTS

CERTIFICATE :-1. Certified that above participant is a bonafide 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

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

MEDICAL CERTIFICATE

This is to certify that ------Of class ------of KendriyaVidyalaya ------, has been medically examined by me.

He/She is not suffering from any disease. He / She is fit to participate in games & Sports events.

Date:------- SIGNATURE of Medical Officer with seal

Place :------

------

NO OBJECTION CERTIFICATE OF PARENT.

I have no objection in sending my ward ––––––––––––––––Of class-––––for practice of his-––––––––––– event/game and if selected for different level coaching and further participation at

(a)Cluster Level sports Meet to be held at ------w.e.f. –------

(b)Regional level sports Meet to be held at –––––––––––– w.e.f.-––––––––––––

(d) KVS SGFI Level Sports Meet to be held at KV––––––––––––––––––––––– REGION w.e.f.--

In the event of the selection of my ward I will have no objection to send him, as per mentioned above level and venue with the escort teacher.

Yours Faithfully,

Date: - –––––––––––– Sign. Of parents. :-

Place: - Name of Parents :- Mr

Mob.------(O):-

RISK CERTIFICATE OF PARENT

I –––––––––––––------ofCLASS--––––––SON / DAUGHTER of ––––––––––––––in––––––––––––––––––––––––––Agree to take Part in ––––––––––– event/sports programme organised by KVS declared that I am doing it at my own risk and responsibility I further declare that KVS shall not in any way be liable to me or my dependents for any loss, Damage. Disability or injury being sustained by me from my participation in the above mentioned.

Yours Faithfully.

Date: - –––––––––– Sign. Of participants:-

Place: - PUNE NAME of Participants :-

FATHER of ––––––––––––––––––––––––of class sec—–––––, have no objection in my son /daughter participating in –––––––––––––– Event/Game organized by KVS w.e.f

Yours faithfully . SIGN. Of Parents.

Date: - ––––––––––––– Name of Parents:-Mr ––––––––––––––

PLACE- –––––––––––––Mob------

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