ADMISSION FORM

Please fill out all required fields marked with *

REGISTRATION DETAILS

Registration Number

Registration Date

Admission Seeking In *

Play Group Nursery Prep. Junior Prep. Senior Mother Toddler Day Care

STUDENT INFORMATION

Full Name *

Date of Birth *

Gender *

Male Female

Home Address *

City *

State *

Zip Code *

Place of Birth

Nationality

First Language

Other Languages Known

Previous School (if any)

PARENT/GUARDIAN INFORMATION

Primary Guardian

Primary Guardian Name *

Relationship to Student *

Mother Father Other

If Other, please specify

Phone Number *

Email Address *

Home Address (if different from student)

Secondary Guardian

Secondary Guardian Name

Relationship to Student

Mother Father Other

If Other, please specify

Phone Number

Email Address

EMERGENCY CONTACT INFORMATION

Emergency Contact Name *

Relationship to Student *

Phone Number *

Alternate Phone Number

Home Address

MEDICAL INFORMATION

Does the student have any allergies? *

Yes No

If yes, please list

Does the student have any medical conditions we should be aware of? *

Yes No

If yes, please specify

Primary Physician Name

Physician Phone Number

Health Insurance Provider

Policy Number

CONSENT & AGREEMENT

I certify that the above information is correct to the best of my knowledge. *

Documents Submitted *

Birth Certificate Immunization Records Proof of Address Other

If Other, please specify

I give permission for my child to receive emergency medical treatment if necessary. *

I understand that submitting this form does not guarantee admission; the school will review applications and notify parents accordingly. *

Date *

Parent/Guardian Digital Signature *

Ready to Submit?

Please review all information before submitting. Our team will contact you within 2-3 business days.

Thank you for your application!

Your admission form has been submitted successfully. Our admissions team will review your application and contact you within 2-3 business days.