Registration Form

WELCOME!
Thank you for your interest in Knowledge Origin. We consider it our privilege to support and care for your child and accompany them as they embark on a journey of learning and exploration. Keeping play our primary focus of learning and engaging child’s interest through innovative techniques and with a passionate and dedicated team of staff, we are set to
build a strong foundation for a life time of learning.

At Knowledge Origin we believe; “Nature and Nurture” are two most important elements that crafts an individual’s life.

“Our goal is to nurture each child’s unique qualities and
potentials “

Thank You,
Josephine Kiran Raj.

Child Information

Name

Preferred Name

Date of Birth

Gender

Male Female

School Going to

Grade/Class

Parents Information

Mother's Name

Place of employment

Address

Mobile Number

E-mail address

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Father's Name

Place of employment

Address

Mobile Number

E-mail address

You parent/Guardian has to list at least one emergency contact with whom you feel leaving your child and who will take responsibility of your child if you could not be reached immediately in an emergency.

Emergency 1

Name

Relationship

Address

Contact Number

Emergency 2

Name

Relationship

Address

Contact Number

Child’s Physician:

Name

Contact Number

Hospital/Clinic:

Medical Information:

Allergies, if yes specify

Any medical conditions, if yes specify

Parent Signature

Describe your Child’s daily routine

What do you and your child like doing together, like favourite activity?

What is your child most interested in doing?

How do you handle dispute or what techniques you use to discipline your child?

What is your child’s most favourite part of the day?

Describe family time in one sentence