School Application Form

BOPHELONG COMMUNITY INDEPENDENT SCHOOL

2024
Student Name

First NameLast Name
Age
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Place of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level
School Year
School Last Attended
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Phone Number
Please enter a valid phone number.
Occupation
Parent/Guardian's Name - Secondary

First NameLast 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 NameLast 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

Reminders
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

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Date Signed

MonthDayYear
Date
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BOPHELONG COMMUNITY INDEPENDENT SCHOOL