EYFS & Keystage 1 & 2

First Name of Child *

Surname of Child *

Child's Pet Name

Date of Birth *

Gender *
—Please choose an option—MaleFemale

Age at Admission *
0 - 6 Months6 - 12 Months1 - 2 Years2 - 4 Years4 - 7 YearsAbove 7 Years

Height *

Weight *

Class at Admission *

Nationality *

Blood Group

Genotype

Religion *

State of Origin *

L.G.A. *

Residential Address *

Father's Name *

Father's Mobile Phone Number *

Father's Occupation *

Father's Email Address *

Father's Office Address *

Mother's Name *

Mother's Mobile Phone Number *

Mother's Occupation *

Mother's Email Address *

Mother's Office Address *

Name of Family Doctor (If any)

Phone Number of Family Doctor

Should Doctor be contacted in case of emergency?
YesNo

Hours Requested *
6:50am - 02:30pm6:50am - 05:30pm

What kind of food does the child like? (Please list more than one in order of preference) *

Mode of Preparation *

Child's Feeding Interval *

Child's Passport *

Father's Passport *

Mother's Passport *

Immunization Chart *

Birth Certificate *

Passport of Proxy Intended (Where Necessary)

Payment Method *
Bank TransferChequeCash

Privacy Policy Acceptance *
Yes, I consent to my data being stored according to the guidelines set out in the Privacy Policy.