Pre-school Application form (2-5Years ) Application Code * Click here to get application code! Name * First Middle Last Sex * Male Female Date of Birth * State what language your child understands or speaks. Is your child toilet trained? * Yes No YOUR CHILD'S HEALTH Please provide us with details about your child's health. For immunizations, tick the ones your child has received and the dates of each. Please tick appropriately IMMUNIZATION Triple Antigen 1 Triple Antigen 2 Triple Antigen 3 BCG Measles Triple Antigen 1 Date Triple Antigen 2 Date Triple Antigen 3 Date BCG Date Measles Date Is your child allergic to any medication or foods? (e.g. Penicillin) Specify * What is your child’s current health problem? * Give address and name of your child’s physician. * SECTION B: Information on Parents/Guardian Please provide us with more information on the child's caregiver Title * Mr. Mrs. Engr Dr. Prof. Name * First Middle Last Occupation and Designation * Home Address * Phone No * Office Address * Official Phone No (if any) Marital Status * Are you living with your spouse? Please, state the number of children, their ages and sexes * Religion Denomination Please state the address of your worship center * Your designation at the center * Who do we contact in case of an emergency? Name * Home Address * Phone No * Office Address * Official Phone No (if any) Statement of Co-operation In making an application for my child, it is my desire to have him/her complete the school year. It is also my understanding that the policy of the school is to make no refund on registration fees. I also give permission for my child to take part in all school activities including sports and school-sponsored trips away from school premises. Parent/Guardians Name Phone Number Email Address Comments
