School Year 2019/2020 2020/2021 2021/2022
Class Playgroup Nursery 1 Nursery 2 Kindergarten Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 JHS 1 JHS 2 JHS 3
Date of Birth
Nationality
Name of Present School
Contact Name, Present School
Phone Number, Present School
Current Class
Date Attended From
Date Attended To
Blood Group
Food Allergies if Any
Family Doctor Name
Medicine Allergies if Any
Family Doctor's Phone Number
Current Ailments or Diseases Being Treated For
Communicable Diseases the Child Had in the Past Eg: Chicken pox, Whooping Cough
Has the child been hospitalized before?
If Yes, When and Why?
Can the student take part in physical activities?
Sibling Information - Name, Class, School
Has the student been double promoted or repeated? If yes provide details
Has the student been expelled from any school? If yes provide details
Please mention special talents that the student has
Parent/Guardian Marital Status
School communication should go to? Options will be (mother, father, both mother and father, guardian)
Father's Name
Mother's Name
Father's Occupation
Mother's Occupation
Father's Educational Level
Mother's Educational Level
Father's Mobile Number
Mother's Mobile Number
Father's E-mail
Mother's E-mail
Father's Address
Mother’s Address (If different from father’s address)
Is there a guardian? Yes No
If Yes, Name of Guardian
Relationship with Student
Telephone Number of Guardian
Email of Guardian
Address of Guardian
Emergency Contact Name
Emergency Contact Telephone Number
Emergency Contact Email
Relationship with Student
Address of Emergency Contact
