Enrollment - Register To Join MotherHen

A. Student Information

Tell us a bit about the child applying for enrolment.

Full Name

Gender

Male

Female

Date of Birth

Place of Birth

Nationality

Home Language(s)

Start Date

Admission Level

Day Care

Baby Class

Pre-School (Reception)

B. Parent / Guardian Information

Please tick which parent is completing this form.

1. Mother / Guardian

I am the parent/guardian filling out this form

Full Name

ID/Passport Number

Occupation

Phone Number

Email

Residential Address

2. Father / Guardian

I am the parent/guardian filling out this form

Full Name

ID/Passport Number

Occupation

Phone Number

Email

Residential Address

+ Add a Guardian (if applicable)

3. Guardian

I am the guardian filling out this form

Full Name

ID/Passport Number

Occupation

Phone Number

Email

Residential Address

C. Emergency Contact & Medical Information

Who should we contact in an emergency, and what should we know about the child's health?

Emergency Contact (Other Than Parent)

Full Name

Relation to Child

Phone Number

Alternative Number

Medical Information (type "none" if unsure.)

Doctor's Name

Clinic / Hospital

Doctor's Contact

Medical Aid (If Any)

Medical Aid Number

Allergies (Food/Medication)

Special Medical Conditions

D. Permissions & Support Needs

A few final details, and your consent to complete the application.

Pick-Up Authorization

List everyone (besides the parents/guardians above) who is allowed to collect the child.

Photo/Video Consent

Yes, I allow the school to use my child's photos/videos for school activities

No, I do not allow

Outdoor Activities Consent

Yes

No

Support Needs

Does the child have any special learning, behavioural, or developmental needs?

Yes

No

If yes, please explain

Student Admission Form

A. Student Information

B. Parent / Guardian Information

C. Emergency Contact & Medical Information

D. Permissions & Support Needs