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Br. G. D. Patil Gymkhana, Shantiniketan. Sangli

Shantiniketan Lokvidyapith, Sangli - 416416 (Maharashtra)

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Surname : Name : Father's Name : Mother's Name : Boy : Date of Birth : Address : Girl : E-mail :

Phone ( with STD code ) :

Mobile :

Local Guardian :

Phone ( with STD code ) :

Mobile :

DD Details ( Fees should be paid in cash or DD drawn in the name of MSPD CAMP, Sangli) Name of Bank: Amount:

Place :

Date :

DD Date :

Participant's Signature

To The working president , I seek an admission to my daughter/ son for the MSPD Camp organized during 30th April to 22nd May. I have read all the rules, regulation and disciplinary notes of the camp.I agree the same & will not hold you responsible for any accident, loss or natural calamities, during the camp. I assure that he/she will not behave in indecent manner. Kindly grant an admission. Thanking you (Admission Forms will be accepted till 25th April Only.)

Parent's Signature



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