Early Years – KIA LAKESIDE ACADEMY

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Early Years

Personal Information

Surname of Child

First Name of Child

Middle Name of Child

Date of Birth

Age

Gender

Nationality

State

Religion

School Last Attended

Class Intended

Residential Address

Father’s Name

Father's Office Address

Father's Phone Number

Mother’s Name

Mother's Office Address

Mother's Phone Number

Upload passport photograph

Emergency Contacts

Emergency Contact 1 Name

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Phone Number

Designated pick up person 1 Name

Designated pick up person 1 Phone Number

Designated pick up person 2 Name

Designated pick up person 2 Phone Number

Admission Medical Form

Place of Birth

Weight at Birth

Have you completed your immunization?

If no which is left?

Allergies?

If yes to what drug or food?

Blood Group

Genotype

Any peculiar medical condition

Other Information from Parents

Attestation

I hereby attest that the information given above is true and promise to notify the school if the above information changes.

Plot 1176, Babafemi Ogundipe Boulevard, Cadastral Zone B03, Wuye, Abuja.

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KIA LAKESIDE ACADEMY

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