Seekers EcoSchool Application Form

APPLICATION FORM

A School with Education in Mind and Mother Nature in our Heart
Student Information
Name

First NameLast Name
Birth Date

MonthDayYear
Country of Birth
Gender
Current Residence Information
Address

Street Address

Street Address Line 2

City

Country
Home Phone Number

Area CodePhone Number
Primary Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parents Information
Mother's Name

First NameLast Name
Mother's Phone Number

Area CodePhone Number
Mother's Profession
Mother's Email
example@example.com
Father's Name

First NameLast Name
Father's Phone Number

Area CodePhone Number
Father's Profession
Father's Email
example@example.com
Physician and Medical Information
Doctor's Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Previous School
School Name
City
Country
Date Started

MonthDayYear
Date Ended

MonthDayYear
Required Documents
Please submit a copy of: student's birth certificate, student's vaccine sheet, parents' passports/IDs, student's photo (passport size), and student's final report card from previous school (if applicable)

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Notes
Please inform us of any other vital information you think we may need to know in the event of an emergency. Thank you.
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Parents Information