School Application Form
Student Name
First Name
Last Name
Age
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Place of Birth
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Level
School Year
School Last Attended
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian's Information
Parent/Guardian's Name - Primary
First Name
Last Name
Phone Number
Please enter a valid phone number.
Occupation
Parent/Guardian's Name - Secondary
First Name
Last Name
Phone Number
Please enter a valid phone number.
Occupation
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person
First Name
Last Name
Emergency Phone Number
Please enter a valid phone number.
File Upload
2x2 Colored ID Picture, birth certificate, report card from the previous school, certificate of good moral, and medical clearance.
Upload
Health History
If the student have any allergies, please list them down below:
Does the student currently taking any medications? If yes, please list them down below:
Was the student previously hospitalized or undergo any surgery?
Does the student have any medical conditions that you would like to declare?
Immunization/Vaccination
Vaccinated?
Year
BCG
Yes
No
Hepatitis B
Yes
No
Pneumococcal
Yes
No
HPV
Yes
No
Varicella
Yes
No
Tetanus
Yes
No
Meningitis
Yes
No
Measles
Yes
No
Mumps
Yes
No
Rubella
Yes
No
Rabies
Yes
No
Polio
Yes
No
Reminders
TEST.
The school required new students or a transferee to take an exam in order to get admitted to the school.
INTERVIEW.
The school admin will conduct an interview with the student as part of the screening test.
REQUIREMENTS.
It is important to pass and complete all requirements before school starts. Failure to do so may delay the student from coming to school.
MEDICAL CLEARANCE.
The school required all students to have a yearly physical exam. For new students, medical clearance for their doctor or school doctor is required.
BEHAVIOR.
A certificate of good moral is required in order to get admitted to this school. Please request it from the previous school as soon as possible.
Parent/Guardian Signature
Clear
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform