Student Registration Form

If you have any questions please call us on +1 876 844 3928

Student Name*

First NameMiddle NameLast Name

What s/he likes to be called:

Is s/he transferring from another school?*

Birth Date*

MonthDayYear

Gender*

Student Age*

Which program are you registering for:

School Attended

First Language

Parent/Guardian Details*

First NameMiddle NameLast Name

Address (Street Address, City, State / Province & Postal / Zip Code)*

Work Address (Street Address, City, State / Province & Postal / Zip Code)*

Does the student have a NSRS

YESNO

If YES, please provide details.

Does this child normally live at this address?

YESNO

Parent's E-mail*

example@example.com

Mobile Number*

Area CodePhone Number

Phone Number

Area CodePhone Number

Does this person have parental responsibility?

YESNO

Does anyone else have parental responsibility for this child?

YESNO

If YES, please provide details.

Emergency Contact Details*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship to the child

Please state the names of any other authorised people who will be able to collect your child

Child Doctor

First NameLast Name

Doctor's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Doctor's Phone Number

Area CodePhone Number

Please detail any additional/special needs your child has: (Please provide full details)

Please detail any dietary requirements/Food allergies for your child (Please provide full details)

Is there anything your child doesn't like (Food, games etc) or is scared of?

What are your child's favourite activities?

Medical History*

	YES	NO	DATES	REMARKS
Asthma / Bronchitis
Rheumatic Fever / Rh. Heart Disease
Congenital / other Heart Disease
Sickle Cell Trait / Disease
Seizures (Epilepsy / Fits Fainting spells / Giddiness Anaemia weak blood)
Excess Tiredness
Disorders of the Ears, Nose, Throat
Diabetes Mellitus (Sugar)
Chronic Disease (e.g. Cancer / Thyroid
Arthritis
Recurrent Headaches / Migraine
Visual or Hearing Disorders
Physical Disability
Infectious Disease (e.g. Measles, Tuberculosis (TB), Mumps, Typhoid fever, Allergies to: penicillin / Antibiotics
Allergies to any other substance
Any other condition
Has your child ever been admitted to hospital or had surgery (if YES please explain for what reason)

Regular Medications Taken (If Any)

Emotional History (Has your child ever been diagnosed with the following?)*

	YES	NO	DATES	REMARKS
Depression
Learning Disability
Hyperactivity (ADHD)
Behaviour Disorder

Has your child experienced any of the following?*

	YES	NO	DATES	REMARKS
Recent Stress e.g. death or relocation of a close family member, relative or friend?
Difficulty making friends, adjusting to new situations
Difficulty concentrating in class
History of fighting / hurting others

Family History (Has any family member been diagnosed with the following*

	YES	NO	DATES	REMARKS
Allergies
Mental Disorder
Sickle Cell Disease
Migraine

Additional Comments

Take Photo*

Parental Contract

South Starz Academy places emphasis on our reputation as a resource centre that seeks to promote minds at varying levels and abilities of academic and co-curricular development, as well as the extended social, emotional, physical and moral development of the holistic individual. In order to accomplish this, we require that all parents and guardians of their child enter into a common contract with the school. Please read carefully the contract so as to be aware of the terms and conditions to which you are agreeing to.

AS A PARENT OR GUARDIAN, I WILL:

1. Make full payment of the school fees before each term begins.

2. Support the school’s rules and Code of Conduct and teach my child to do the same.

3. Be respectful and pragmatic in my interactions with members of the school such as Administrations,

4. Ensure that my child will attend school on time each and every day of the year most of the time.

5. Ensure that my child is dressed (uniform, crest etc.) according to Academy expectations.

6. Ensure that my child is properly groomed at all times for regular contact sessions and other officials Academy activities.

7. Provide books, class materials and equipment that are necessary for my child's academic improvement/success.

8. Ensure that I will monitor my child's preparation for Homework, Assignments, Six Week Tests/Forms/Term and yearly exams with him/her so as to maximize their development.

9. Inform the academy verbally if my child will be absent from school for a day or more.

10. Encourage my child to conduct him/herself to school and from school.

11. Ensure that my child/children is/are picked up by an authorised person.

12. If my child has a contagious illness, he/she will only be readmitted to the institution on the production of a doctor’s confirmation by a letter to prove the child is fit to return.

13. Ensure that no personal belongings are brought into the institution eg. Toys, I-pad, Tablets, Phones etc. as no responsibility is taken by the institution for the loss or damage of any item.

14. Make an appointment to speak with the class teacher when necessary.

15. Ensure that my child/ward refrains from bullying and if that occurs disciplinary action will be taken by the school board.

16. Accept full responsibilities if my child damages school property and will replace said property if required.

I understand that this permission will last for one academic school year unless I write a letter to discontinue.

Signature*

How did you hear about us:

Social MediaWord of mouthOther

About Your Child

Medical