Student Registration - Picasso PreSchool

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Student Registration

DETAILS OF CHILD

Surname *

Nickname *

First names *

Gender *

Date of birth *

Nationality *

Language(s) spoken at home *

Previous school(s)

Year of entry in to Primary school & attended school

DETAILS OF PARENTS / GUARDIANS(FATHER)

Surname *

First Name *

Occupation

Employer

Telephone No(H)

Telephone No(W)

Cellphone No

Email Address

Physical address of employment

Postal address

DETAILS OF PARENTS / GUARDIANS(MOTHER)

Surname *

First names *

Occupation

Employer

Telephone No(H)

Telephone No(W)

Cellphone No

Email Address

Physical address of employment

Postal address

NEXT OF KIN(Emergency contact)

Surname *

First Name *

Telephone No(H) *

Telephone No(W)

Cellphone No *

Relationship *

Surname

First Name

Telephone No(H)

Telephone No(W)

Cellphone No

Relationship

LEARNER MEDICAL INFORMATION

Medical aid

Card expiry date

Any other insurance (Company and Policy)

State the insurance (Company and Policy)

Is there a Doctor assigned to the learner ?

Students Doctors Contacts

Does the learner have any allergies?

If yes please list them

Indicate the problems the student might be experiencing: Social; Medical; Emotional; Physical.

If yes please list the medications

Has the learner been diagnosed with ASTHMA?

Does the student require an inhaler for ASTHMA?

Does the learner carry any kind of MEDICAL PROBLEM, SOCIAL, EMOTIONAL PROBLEMS OR DISABILITIES?

Please Explain in detail

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