Milton High School
3 Ojimba StreetOff Addo Raoad AjahLekki, Lagos
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Place of Birth
Gender
Male
Female
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Level
*
School Year
*
School Last Attended
*
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian's Information
Parent/Guardian's Name - Primary
*
First Name
Last Name
Occupation
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian's Name - Secondary
First Name
Last Name
Occupation
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person
*
First Name
Last Name
Emergency Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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?
Reminders
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Signature
Submit
Submit
Should be Empty: