EUREEKA INSTITUTE OF COMPUTER AND FINE ARTS

EUREEKA EDUCATION AND SERVICES

An Autonomous Institution Under Assam Trust Act 1882

Admission open for new season 2025-26

1. Personal Information

Center

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Student Name

Parent/Guardian Name

Date of Birth

Gender
Male Female Other

Address

Contact Number

Email (if any)

2. Yoga Class Details

Class Type

Preferred Timing

Admission Duration

3. Health Information (Optional)

Do you have any medical condition?
Yes No

If yes, specify

Any special doctor advice?
Yes No

4. Declaration

I confirm that the details provided are correct. I agree to follow all safety rules. EUREEKA WELLNESS ACADEMY is not responsible for any injury.