JSA Registration Form
Registration Fee: 2,500/- (Paybill - 522123 Account # 83414K Student Name)
Student's Name:
*
First Name
Last Name
Gender
Grade (Applying for)
Jawabu School Campus Name? - (Acacia Village or Kiserian - Magadi Rd)
Birthday
Age
Father's Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Mother's Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Physical Location/Estate Name/House No/Town
Emergency Contact
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Name of Preferred Doctor
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Preferred Hospital
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
Former School's Name
City
Date Started
Date Ended
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
Registration fee - 2,500/- ( Write Confirmation Message)
*
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