Online Admission

Online Admission Form

Family Relationship

Family

Pupils' Health history/ records

Final Declaration

  • Child Bio
  • Family Relationship
  • Pupil's health Records
  • Final Declaration

Admission Form

CHILD'S BIO-DATA

First Name

Last Name:

Middle Name

Date of Birth

Zone/ Village

Sub-county/ Division

Home District/ Municipality

Previous School

Previous Class if any

Location of previous school

Previous residence if changed

Date of Birth

Birth Position

Orphan Status (tICK)

Religion/ Sec/ Denomination

Number of brothers and Sisters

Child Photo

Max. size: 8.0 GB

Family Relationship

Mothers name

Tel

Current residence

Mothers Email Address

Any social media account (Facebook, WhatsApp no. etc.)

Ocuupation

Work place and address

Office Tel

Marital Status

Next of KIN (N.O.K)

N.O.K Tel

Relationship to N.O.K

Next of KIN (N.O.K)

N.O.K Tel

Relationship to N.O.K

Father's Name

Tel:

Fathers E-mail Address

Residential Address/ Current

Father 's Martial Status

Occupation

Work Place

Office tel contact

Location of work Place

Next of Kin (N.O.K)

Tel

Relationship to N.O.K

Next of Kin (N.O.K)

Tel

Next of Kin (N.O.K)

Email

Any social media account (Facebook, WhatsApp no, etc

Pupils' Health history/ records

Any physical disability

If yes, specify it:

Pupil's personal/ family doctor's name

Tel

Email

Doctor's social network account (Facebook/ WhatsApp)

Special child's health facility if any

Any types of food stuffs the child does not eat?

Any types of food stuffs the child does not eat? If Yes, Specify Name them

Have you suffered from any chronic disease?

If Yes, specify / name them;

Are you on medication?

If yes, specify below;

How often do you go for the medical check-up?

Medical Form for Admission (Fitness)

Pupil's Name

Age/ Years

Weight (kgs)

Sex

Parent / Guardian's Name

Current Residence

Tel

History of Epilepsy

History of Candidiasis (Girl)

History of Typhoid

History of Hepatitis

IMMUNISATION RECORDS

Have you immunized for Polio

Hoping to take up immunization

Have you immunized Small Pox

Hoping to take up immunization

Malaria Frequency

Do you have any of the following texted positive. Tick IF Yes

Does the child have any of the following impairments/ deformities ? Tick if Yes

If others, Specify

Clinic Results

Kindly comment on the results got after testing the following

Blood

Stool analysis

Kidney

Stomach

Urine analysis

Chest

Any fibroids tested and scanned (Girls) ?

Other

Doctor's general remarks

Doctor's Name

Doctors Tel

Doctor's Email

Social Network if any

Hospital/ clinic/ health center Name

Final Declaration

Terms and Conditions

Declaration

I hereby declare that i will abide by the above rules and regulations as set and followed at RICH DAD JUNIOR SCHOOL.

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