MimShaack Crest School Admission Form

Entrance Form

MimShaack Crest Nursery & Primary School
Applicant's Details
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Full Name*

SurnameOther names
Date of Birth

DayMonthYear
Date
Gender*

MaleFemale
Nationality*
State of Origin*
LGA*
Class to Enroll*
Registration Date*

MonthDayYear
Date
Parent's Photo*
Father's Details
Father's Details*

NameOccupation
Address*

Office Address

Home AddressState

Zip Code
Father's Phone Number*

Country CodePhone Number
Father's E-mail
Email
Mother's Details
Mother's Details*

NameOccupation
Address*

Office Address

Home AddressState

Zip Code
Mother's Phone Number*

Country CodePhone Number
Mother's E-mail
Email
Guardian's Details
Guardian's Details (where applicant does not live with the parents)

NameOccupation
Address

Office Address

Home AddressState

Zip Code
Guardian's Phone Number

Country CodePhone Number
Guardian's E-mail
Email
Applicant's Health Status
Does the applicant have any of these specific health conditions?

Sickle Cell AnemiaAshmaEpilepsyWhooping CoughDiabetesMental IllnessOther
Has the applicant been immunized against the following:

Fellow FeverMumpsMeaslesChicken PoxPolio
(Select the appropriate) The applicant is:
How did you come to know about our school?

Poster/FlyersStudentStaffParentInternet
Any health challenges? If yes give details
I, certify that my child has no health challenges
Declaration
I,agree to abide by the rules and regulations of Mimshaack Crest School. I acknowledge their capability to groom my child academically and morally without any sense of doubt on the well being of my child
Applican's Signature

Clear
Parent's Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Entrance Form