Registration form:

PERSONAL INFORMATION

 

ENROLMENT DATE:

 

 

 

Childs name and surname:

 

Date of birth:

 

Gender:

 

 

 

 

Religion:

 

Home Language:

 

 

 

     

Previous School:

 

 

 

 

 

 

Position in Family (1st,2nd, only child)

 

 

 

Details of Mother:

   

Details of Father:

   

Full Name:

 

 

Full Name:

 

 

I.D. Number

 

 

I.D. Number

 

 

(please include a photocopy of your ID)

(please include a photocopy of your ID)

Physical address:

 

 

Physical address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postal address:

 

 

Postal address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home phone no:

 

 

Home phone no:

 

 

Work phone no:

 

 

Work phone no:

 

 

Cell Phone no:

 

 

Cell Phone no:

 

 

Email address:

 

 

Email address:

 

 

Occupation:

 

 

Occupation:

 

 

Hobbies/interest:

 

 

Hobbies/interests:

 

 

 

 

 

 

 

 

 

 

Contact person (other than parent) Emergency no 1:

 

 

Contact person (other than parent) Emergency no 2:

 

 

MEDICAL INFORMATION (please attach a copy of your childs immunization card)

Child’s Pediatrician:

 

Contact phone no:

 

Family Doctor:

 

 

Contact phone no:

 

Vaccinations:

 

 

Prior illness:

 

 

Allergies:

 

 

       

Medical Aid:

 

 

Membership number:

 

 

 

 

 

(please include a photocopy of card)

In emergencey, which parent should be contacted?

 

 

Does your child have any special diet?

 

 

 

Do you have any special requests for your child?

 

 

               

I, _________________________Parent/Guardian of _____________________decalre that the

above information is correct and agree to abide by the rules and regulations

 and the terms and conditions which are attached to this document.

               

PARENT’S SIGNATURES:

         

MOTHER:

 

 

 

Witness 1:

 

 

 

FATHER:

 

 

 

Witness 2:

 

 

 

Date: