School Registration Form

Study in your Dream School Abroad
Additional documents for registration

Bring this registration form and the following documentation to the office.

• Original Certified Birth Certificate
• Original National Card
• Current Immunization Form
Student Information
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Ethnicity
Email Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Grade
Semester
YesNo
If yes, what year?
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Preferred Hospital
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Previous School
School Name
City
State
Date Started

MonthDayYear
Date Ended

MonthDayYear
Notes
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
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