ST. FRANCIS PRIMARY AND INFANT SCHOOL REGISTRATION FORM
Infant Department
CHILD'S FULL NAME
DATE OF BIRTH
-
Month
-
Day
Year
Date
GENDER
MALE
FEMALE
HOUSE
BIRTH CERTIFICATE NUMBER
VACCINATION CERTIFICATION
STUDENT'S REGRISTRATION NUMBER
PATH NUMBER
HOME ADDRESS
FATHER'S INFORMATION
FATHER'S NAME
ADDRESS
FATHER'S PHONE No
EMAIL ADDRESS
FATHER'S OCCUPATION
EMPLOYER
MOTHER'S INFORMATION
MOTHER'S NAME
ADDRESS
MOTHER'S PHONE No
EMAIL ADDRESS
MOTHER'S OCCUPATION
EMPLOYER
GUARDIAN'S INFORMATION
GUARDIAN'S NAME
PHONE No
GUARDIAN'S ADDRESS
GUARDIAN'S RELATIONSHIP TO CHILD
GUARDIAN'S OCCUPATION
EMPLOYER
EMERGENCY CONTACT #1
NAME
PHONE No
RELATIONSHIP TO CHILD
EMERGENCY CONTACT #2
NAME
PHONE No
RELATIONSHIP TO CHILD
Please type the name of three (3) persons who may collect your child from school (not parent or guardian stated above)
Person 1
Tel #
Person 2
Tel #
Person 3
Tel #
NUMBER OF OLDER BROTHER(S)
NUMBER OF YOUNGER BROTHER(S)
NUMBER OF OLDER SISTER(S)
NUMBER OF YOUNGER SISTER(S)
LAST SCHOOL ATTENDED
GRADE REACHED
NAME & GRADE OF RELATIVES IN THIS SCHOOL
CHURCH CHILD WAS CHRISTENED
CHURCH CHILD ATTENDS
IF CHILD IS CATHOLIC
CHURCH OF BAPTISM
DATE
-
Month
-
Day
Year
Date
VOL. R #
CHURCH OF COMMUNION
DATE
-
Month
-
Day
Year
Date
CHURCH OF CONFIRMATION
DATE
-
Month
-
Day
Year
Date
MEDICAL
Doctor’s Name
Telephone
Allergies
Special Illness (If any)
Special Instruction
Has your child ever been diagnosed or treated for any of the following conditions? Check the appropriate box.
Asthma
Bronchitis
Heart Disease
Epilepsy (Fits)
Fainting Spells
Sickle Cell Trait/Disease
Any other condition?
Please state the condition (mentioned above) and make any remark needed.
Has the child ever been admitted to hospital or had surgery?
Yes
No
If yes, please state the reason.
Thank you for choosing St. Francis Primary and Infant School!
Signature of Applicant
Date
OFFICE ONLY
ITEMS PRESENTED
Birth Certificate
Passport size picture
Immunization Card
Medical Form A
Medical Form B
Submit
Should be Empty: