Student Application Form

Pupil’s Surname
First Name
Other Names
Date of Birth	DD/MM/YYYY
Gender	Male Female
Attach Photograph	Fill cannot be more than 2MB
Current Primary School
Full Address
Parent or Guardian Details
Phone Number
Mobile Number
Email
Full Name
Phone Number
Contact Address
Contact Email
Does your child have a statement of special Education needs?	Does your child have a statement of special Education needs? Yes No
Are there any exceptional medical concerns?	Are there any exceptional medical concerns? Yes No
Is your child covered by the National Health Insurance Scheme?	Is your child covered by the National Health Insurance Scheme? Yes No
If yes, which Health Maintenance Organization (HMO)?
I consent to the medical treatment of my child, in the event of a health emergency, at Almadina Clinic, No 28 Queen Elizabeth Road, G.R.A., Zaria. Pending my arrival and undertake to bear the cost incurred.
I undertake to pay my Child’s school fees on or before commencement of tuition and understand that school fees are not refundable.