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Name: Ms./Mr.*

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Date of birth*

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Appeared/Appearing in Examination of*

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Awards/ Achievements*

Special Skills/ Interests/ Hobbies*

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About Parents/ Guardian

Mother Name*

Occupation*

E-mail*

Mobile*

Father Name*

Occupation*

E-mail*

Mobile*

Guardian Name (If applicable)

Occupation

E-mail

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Tele Nos with STD code Office

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Source details

DECLARATION

I, Father/ Mother/ Guardian of Mr./ Ms. Hereby declare as under:

In the event of any sickness, accident or any other mishap during the Camp at EDII, I shall not hold EDII responsible in any way and would bear all costs/damages arising out of any such eventuality.

Dr. Pankaj Bharti, Camp Leader
Entrepreneurship Development Institute of India,
P.O. Bhat – 382 428
Dist. Gandhinagar (Gujarat)

Tel: +91–79–69104927/ 4954 / 4900 / 4999 / 5000
Mobile: +91 9924441365, 9998187769
E mail: camps@ediindia.org, pbharti@ediindia.org

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