CMI Preparatory School - Full-time School Admission Form

Full-time School Admission Form

Caribbean Mind Institute is a specialty institution which caters to the educational needs of children who are in need of specialized or individual attention.
School Information

Tel: 546-6925/257-1124 | Email: info@caribbeanmindinstitute.com | Location: 6th Ave, Belleville, St. Michael
Personal Information
Student's Name:*

First NameMiddle NameLast Name
MaleFemale
Date of Birth:*

MonthDayYear
Present Age:*
National Registration Number:*
SeptemberJanuaryApril
Age of child at August 31st, 2022:*
Address:*

Street Address

Street Address Line 2

ParishCity

Postal / Zip CodeCountry
Telephone Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Country Of Birth:*
Nationality:*
Religion:*
Previous School/Pre-school (if any):*
Length Of Time There:*
Remedial TuitionClass SizeLocation
Other Reasons:*
Both ParentsMotherFatherGrandparentGuardianOther
Parent/Guardian Information
Mother's Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation/Profession:*
Employer:*
Home Number:*
Format: (000) 000-0000.
Cell Number:*
Format: (000) 000-0000.
Work Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Email:*
example@example.com
Father's Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation/Profession:*
Employer:*
Home Number:*
Format: (000) 000-0000.
Cell Number:*
Format: (000) 000-0000.
Work Number:*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail:*
example@example.com
Grandparent/Guardian Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation/Profession:*
Employer:*
Home Number*
Please enter a valid phone number.Format: (000) 000-0000.
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Work Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email:*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number*
Format: (000) 000-0000.
Health Concerns
Please list any serious illnesses to date:*
Has the child been diagnosed with a learning or functional challenge? If so, please specify:*
Clinical Education Psychologist:
Telephone Number:
Please attach a copy of:
- Birth certificate
- Immunization Record
- Passport Size Photo
File Upload*

Cancelof
Informed Consent & Acknowledgement:

By acknowledging and signing below, I am delivering an Electronic Signature that will have the same effect as an original manual paper signature. The Electronic Signature will be equally as binding as an original manual paper signature.
Should I be offered placement, I understand that this is conditional to my acceptance and compliance with school regulations. All school fees are payable within the payment dates given by the Administrator. It is also understood and agreed that should fees fall into arrears at any time, necessitating the hiring of debt collectors or legal counsel that the parent/guardian will be required to pay an additional 25% and all legal fees incurred in the collection process.
I, First Name* Last Name* have read and understood and do accept the above statement.
Signature:
National Registration:
Date:

MonthDayYear
Date
Should be Empty:

Full-time School Admission Form

School Information