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Admission Form

NB: PLEASE TAKE NOTE THAT PURCHASE or completion (online) OF FORM DOES NOT AUTOMATICALLY GUARANTEE PLACEMENT.

1PERSONAL INFORMATION

2FAMILY DATA - FATHER

3FAMILY DATA - MOTHER

4GUARDIAN

5AGREEMENT

Name of Applicant *

First

Middle

Last

(Print name exactly as it should appear on all permanent records) (Surname)(Other names

Date of Birth *

Place of Birth *

Gender *

Male
Female

Age *

Religious Denomination *

Applicant lives with *

Father
Mother
Both parents
Guardian

Tick where applicable *

Parents Divorced
Father Remarried
Mother Remarried
Father Deceased
Mother Deceased

Applicant’s Interest (e.g. sports) *

Last School Attended *

Current Grade *

Reasons for Withdrawing Applicant *

Applying for grade *

Reasons for choosing Four Rivers International School *

Academic Reputation
Christian Philosophy
Desire to attend Private School
Location
Recommendation of Others
Other

Other Reason *

Has applicant repeated a class before? *

Yes
No

Has applicant ever been suspended or expelled? *

Yes
No

Has applicant been immunized against the six childhood killer diseases? *

Yes
No

Immunizations *

please list them (Bring along immunization card as proof)

Does applicant have any disabilities or medical problem? *

Yes
No

If yes, give details *

Is applicant allergic to any food, drugs or environmental substance? *

Yes
No

If yes, give details (allergies) *

Father's Name *

First

Middle

Last

Father's Religion / Church *

Father's Address (Postal & Residential) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Father's Tel No / Cell No *

Father's Email Address *

Father's No. of Wives

Selected Value: 1

Father's Qualification *

Father's Occupation *

Name & Address of Father's Employer *

FAMILY DATA - MOTHER/h2>

Mother's Name *

First

Middle

Last

Mother's Religion / Church *

Mother's Tel No / Cell No *

Mother's Email Address *

Mother's Qualification *

Number of other children in the home

Selected Value: 1

Older

Younger

Other Relations

Mother's Occupation *

Name & Address of Mother's Employer *

FAMILY DATA - GUARDIAN

Guardian's Name *

First

Middle

Last

Guardian's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Guardian's Occupation *

Guardian's Religion

Guardian's tel. No. *

Guardian's Qualification *

Relationship to Pupil *

Date guardianship began *

Why did you become the Guardian? *

• Fees are payable for each term in advance or before the second week of the term. • School fees and Admission fees once paid and receipted are non- refundable should a child refuse To attend school or be dismissed for misconduct. • No child is considered admitted until the admission fee is paid. • A child will be sent home from school if the term’s fee is not paid. • In the event of a child being withdrawn from the school a term’s notice must be given in writing. Failure to comply with this will attract a full term’s fee payment

Undertaker Nane *

Agreement *

I recognize the importance of my partnership and co-operation with the school to bring out the best in my ward. I fully submit to the policies of the school to ensure its efficient and effective operation. I will be responsible for the payment of school fees and other expenditure that relates to my ward from the date of enrolment.

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