Student Registration Form

LIS

Kinyinya campus/ Kimihurura campus

leadinternationalschool@yahoo.com

www.leadschoolrwanda.com

(250) 788634182
Student Registration Form

Basic Information
Student's Full Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Grade / Class
for Incoming A.Y. '12-'13
If A-Level Please choose option
Father's Names

First NameMiddle NameLast Name
Mother's Names

First NameMiddle NameLast Name
Email
Phone Number

Area CodePhone Number
Present Address

Street Address

CityState / Province

Postal / Zip CodeCountry
Emergency Contact

First NameLast Name
Relationship
ex. Father, Mother, etc.
Address Of Person To Contact In Case Of Emergency

Street Address

Street Address Line 2

CityState / Province

Phone NumberCountry
Phone Number Of Person To Contact In Case Of Emergency

Area CodePhone Number
Email Of Person To Contact In Case Of Emergency
example@example.com

Academic Background
Previous School
Previous class reports

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Any Medical sickness
Suggestions / Comments
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