Pottersland School Admission Form

Child’s Information

Surname First Name Other Names GenderMaleFemale Date of Birth Place of Birth Country of Birth What do we call him/her? Child’s Passport Photo Child’s Birth Certificate

Family Information

Nature of Family Single Parent Monogamous Divorced Separated Polygamous Number of Siblings

Parents’ Information

Father

Name Date of Birth Occupation Nationality Company Designation Telephone Residential Address Email Father's Passport Photo

Mother

Name Date of Birth Occupation Nationality Company Designation Telephone Residential Address Email Mother's Passport Photo

Emergency Contact

Name Relationship Address Telephone Email

Health / Medical

Blood Group Genotype Any Known Disability/Allergy?NoYes If Yes, State Special Instruction for Medical Care

Previous Education

Nationality State of Origin Religion Ethnicity First Language Other Languages Previous Schools Attended Present School Class Address

Siblings

Sibling 1 - Name, School, Age Sibling 2 - Name, School, Age Sibling 3 - Name, School, Age Sibling 4 - Name, School, Age

Miscellaneous

How did you hear about The Pottersland School? Newspaper Website Social Media Word of Mouth / Referral Other If Referral, name & phone number

Declaration

I/We request that our above named child be enrolled as a prospective pupil. I/We understand that the terms and conditions of the school will undergo reasonable changes from time to time as circumstances demand and will apply in our relations with the school. I/We understand that the school may obtain, process and hold personal data about our child including medical information and we consent to this for the purpose of evaluation and, if a place is offered, in order to protect and promote the welfare of our child.

Date

Additional Information

Your Email Additional File