New Pupil Admission Form

ISABELLA MONTESSORI SCHOOLS

News Flash! New Academic Session Starts September 12, 2011--------------- New Academic Session Starts September 12, 2011

New Pupil Admission Form

Surname: Other Names:

Date of Birth Sex: Male Female Nationality:

State of Origin (Nigerian): State of Origin (Non-Nigerian):

Local Govt. Area: Religion:

Contact/Residential Address:

Contact Telephone: Name of Parents/Guardian:

Parents/Guardian Occupation: Business Address:

Tel:

Parents/Guardian Contact Address:

MEDICAL INFORMATION: Has the child any health problem(s) allergies? Yes No

If Yes, please indicate:

Please supply us with scanned copy(ies) of the Child's immunization card and recent passport photograph.

Immunization Card: Immunization Card:

Immunization Card: Passport Photograph:

UNDERTAKING

I certify that the above informations are correct and I should held liable if otherwise. Also, I promise to abide by the rules and regulations laid down by the school's Authority and agree to pay all neccessary fees due in respect of my child/ward in advance and understand that fees are not refundable in any circumstance.

Name: Address:

Tel: Relationship to child:

Upload Signature: Date:

Today's Date & Current Time: