Admission Registration Form Url Surname Name of Student * Other Names of Student * Full Name of Parent/Guardian * Phone Number * Email Address Student Age * Date of Birth * Class / Grade * Former School Name & Address (if applicable) Any Health Condition? Yes None Unknown Has Condition Been Treated? Yes No Not Applicable Please Specify Nature of Health Condition (if Yes is picked above) Has Your Child Been Immunize For? * Measles Chiken Pox Small Pox Polio Hepatithis B Tuberculosis Others Other Immunization (f others is checked) Past Records of any of the following? Convulsion Prolonged Cough Abdominal Pain Allergy Speech Impedance Prolonged Fever Surgery / Operations Prolonged Hospitalization None of the above Action Taken or Expected to be Done? * Any other Information about your Child? Your Full House Address / Nearest Bus Stop?
