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Health and Acticity Card

This document contains a health and activity card for students. It requests that parents fill out the card with information such as the student's name, admission number, date of birth, gender, blood group, parents' names, addresses, contact information, family income, and whether the student has any special needs. The card collects health data like vision, ear, and teeth information that the school needs to upload to the CBSE portal by a deadline of September 10th for student registration and exam forms for classes 9 through 12.

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Rishabh soni
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1K views2 pages

Health and Acticity Card

This document contains a health and activity card for students. It requests that parents fill out the card with information such as the student's name, admission number, date of birth, gender, blood group, parents' names, addresses, contact information, family income, and whether the student has any special needs. The card collects health data like vision, ear, and teeth information that the school needs to upload to the CBSE portal by a deadline of September 10th for student registration and exam forms for classes 9 through 12.

Uploaded by

Rishabh soni
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

HEALTH AND ACTIVITY CARD

GENERAL INFORMATION

Aadhar Card No. of Student : ________________________________________________

Name : _________________________________________________________________

Admission No.: ______________________ DOB : ________________________________

Gender : (M/ F/ T) ___________________ Blood Group : _________________________

Mother’s Name : __________________________________________________________

Year of Birth : ________Weight : _________ Height : _________ Blood Group : ______

Aadhar Card No.: _________________________________________________________

Father’s Name : ___________________________________________________________

Year of Birth : ________Weight : _________ Height : _________ Blood Group : ______

Aadhar Card No.: _________________________________________________________

Family Monthly Income : ____________________________________________________

Address : ________________________________________________________________

________________________________________________________________________

Phone No.: _________________________________ [M] : _______________________

CWSN (Child with special need), SPECIFY _____________________________________

SIGNATURE OF PARENTS/ GUARDIANS DATE: _____________


S. R. PUBLIC SR. SEC. SCHOOL
Date: 03/09/2018

Dear Parents,
In order to upload individual data of students on CBSE portal as prescribed by CBSE, you are
requested to kindly fill the given Health and Activity card and provide us vision, ears and teeth
occlusion in given format latest by 10.09.2018. Without this data we won’t be able to pursue CBSE
registration/ Exam form of your ward for classes IX to XII. In case of any delay on your end school
will not be responsible.

S. No. Components Parameters Remark


Right Eye
1. Vision
Left Eye

Right Ear
2. Ears
Left Ear

3. Teeth Occlusion Caries/ Tonsils/ Gums

Principal
S. R. Public Sr. Sec. School

Declaration

I hereby affirm and declare that the information given herein above is true and correct to the best of
my knowledge and belief.

Name of Parents/ Guardians: ______________________________________________________

Signature: _______________________ Date: ____________________

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