Select gender Male Female Others

Preferred Parent's/ Guardian Details

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Mother's Information

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Father's Information

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Indicate who the pupil/student mainly lives with

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Select custody type Father Mother Both Guardian

Kindly select marital status of parents

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Select marital status Single Married Seperated Widowed Divorced

Child’s health and social record

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Does your child have an existing condition of which the school should be aware?

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Select health status Yes No

Does your child have any known allergies, food, medicine, drinks etc.?

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Select allergy status Yes No

Does your child have a restricted diet, eating difficulties or any other challenge?

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Select child diet status Yes No

Does your child require any medication, therapy or any treatment while in school?

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Select child medication status Yes No

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Select a blood group A+ A- B+ B- AB+ AB- O+ O-

CONSENT:

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I hereby permit the administrator or her delegate to do whatever she considers in best the interest of my child/children. I give consent to the school to first attempt to contact me before administering first aid in the event that child(as filled above) becomes ill or injured during school hours and need medical attention.

Kindly click to consent