Accommodation Application Form PASTE PHOTO HERE To the Administrator, Mom s Care Accommodation Dear Madam, I wish to apply for accommodation to a Residential Flat managed by Mom s Care Accommodation (MCA) for the academic year _ I hereby agree that I have read and will abide by the Rules and Regulations of MCA in force from time to time. I furnish the following: PERSONAL DATA: 1) Full Name (with Surname) 2) Residential Address 3) Email Id 4) Mobile Number 5) Landline Number 6) Date of Birth 7) Nationality I declare that the information given above is true to the best of my knowledge. I agree that if any information furnished above found incorrect my admission is liable to be cancelled.
Signature of the Applicant Date: FAMILY BACKGROUND: 1) Full name of the Parent/Guardian 2) Relationship 3) Occupation/Designation 4) Office Address 5) Email 6) Mobile Number Tel No (STD code) NEAREST LOCAL GUARDIAN A) Name and address of contact person who should be contacted (in case of emergency) 1) Name 2) Address 3) Tel. No. (Mob / Res) B) Name and address of contact person who should be contacted (in case of emergency) 1) Name 2) Address 3) Tel. No. (Mob / Res) I request you to admit my ward to MCA. I give an undertaking that she has read and will observe all Rules & Regulation of the Accommodation. Yours faithfully
Signature of the Parent / Local Guardian RULES AND REGULATIONS Mom s Care Accommodation is available preferably to out-station girl students as a paying guest. At Mom s Care Accommodation confirmation is valid only on submission of complete & true information. Accommodation will be available only for one academic year or ten months whichever is lesser. Paying guests can stay in the flat during the summer vacations (beyond 10 months ) by paying proportionate fees. Students are required to give their consent about continuing the paying guest facilities in the next year, when asked by Administrators. Rent for the next academic year is required to be paid in the month of April. Administrators reserves its right to cancel admission of undeserving students without giving any reason or shift to some other Location. Administrators will not be responsible for any mishap however will put in their best efforts to salvage the situation. Paying guest accommodation in premises is tentative till full payment is received & admission will be confirmed on availability of premises. Paying guest residing in the flat shall strictly observe all the Rules and Regulations in force from time to time. Breach of rules / regulations may invite rustication / fine. Consumption of alcoholic drinks, drugs, spitting and friends of opposite Sex are strictly prohibited in the flat premises. Strict action will be taken against defaulter (as per rules). No guest or visitor including parents of the paying guest will be permitted to visit the premises without permission. On Permission, the visiting timings are 10:00 am to 5:00 pm only. Every paying guest shall be in her flat by 11:00 p.m. In case, the paying guest must stay out after 11:00 pm owing to any special reason, she must obtain prior permission
from the Administrator and Parents. The application for leave of absence from the Accommodation shall be made in writing. Late entry will be permitted only through permission & call from parents. Paying guest will not enter rooms of others without permission of the inmates. Paying guest should not go to other s room after 11.00 p.m. Every case of illness and accident must be reported immediately to Administrators. No parties or celebrations shall be organized except with the permission of the Administrators. Paying guest suffering from any contagious disease will not be allowed to stay in the accommodation. Decision of the Administrator in this regard will be final and binding. Allotment of the room, furniture etc. will be entirely at the discretion of the Administrators and no complaint in this regard will be entertained. Every paying Guest shall keep the room allotted to him neat and clean. She shall take proper care of the furniture and fixtures handed over to her. The Administrator has the right to enter and inspect the rooms at any time, even in the absence of paying guest. Any matter and complaints about the Staff shall be brought to the notice of the Administrators, who will act as may be necessary. No police complaint will be lodged by the students before taking prior permission from the Administrators. Paying guests must switch off the lights, fans, AC and Bathroom Geyser provided in their rooms every time they go out and take precautions to economize electricity consumption. Charges for any damages to the property as well as to the furniture and fixtures caused by paying guest s negligence will be recovered from the paying guests staying in the said premises. Paying guest should not drive nails, screws etc. into the wall or doors. No repair shall be done by the paying guests themselves. They should approach the Administrator who will arrange for repairs.
The rooms allotted is meant only for the use of bona fide paying guest of that room. Visitors are not allowed to enter any room. The Administrator do not hold themselves responsible for the safe custody of the property of the paying guest staying in the Accommodation. Paying guests should lock their cupboards and should take proper care of their belongings. They should not leave the key of the room anywhere around. Administrators will not be responsible for the loss of personal belongings of the paying guests. All the facilities including additional facilities like T.V., Magazines, Newspaper, Internet etc., misused, shall be discontinued without given any notice and disciplinary action will be taken against the paying guests involved. Before leaving the accommodation, a student must pay all dues and hand over the charge of room and other material in satisfactory condition to the Administrator & collect their security Deposit. If any paying guest is found misbehaving and misconducting herself, she will be expelled from the Accommodation immediately and the Rent paid by her will be forfeited. Permission for night outs (only for local guardian and parent s house) should be taken from Administrator and the call by parents should be made before 8.30pm. No music system is allowed in the premises. Any complaint (indecent behavior/noisy) from the neighbors/society will result in severe action. Room is required to be vacated with luggage in every summer vacation. Paying Guest is not permitted partake meals in the room. Paying Guest must sit & dine in the dining area only and if otherwise, they must clean any mess by themselves. Paying guest will have to follow the timings of breakfast, lunch and dinner. Request of the food beyond these timings will not be entertained. Ragging is strictly prohibited inside the premises.
DECLARATION TO BE SIGNED BY THE STUDENT I have read all the Rules and Regulations of the Accommodation. I hereby agree to abide by the rules and regulations of Mom s Care Accommodation in force from time to time. I am liable for disciplinary action in case of any breach. Signature of Student Date Signature of Parent Date