STUDENT BIO-DATA

Admission Into : *

Admission Type : *

Surname: *

First Name : *

Other Name : *

Email Address : *

Phone Number : *

Date of Birth : *

Gender : *

Religion : *

State of Origin : *

L.G.A: *

Home Town : *

Home Address : *

PREVIOUS SCHOOL INFORMATION

School Name :

Proprietor's Name :

Proprietor's Phone :

Present Class :*

Previous School Address :

Type of Education offer :

Reason for change of school :*

Health and Hospital information

Personal Hospital Name:

Doctor's Name :

Hospital Phone Number :

Hospital Card No:

Hospital Address :

Blodd Group :*

Genotype :*

PARENTS'/GUARDIANS DETAIL(S)

Title : *

First Name: *

Last Name: *

Phone: *

whatsApp: *

Occupation: *

Contact address: *

Email Address: *

Relationship: *

PASSPORT (PHOTO) & SCRATCH CARD

Please Note that Passport size must not exceed 100KB and dimension should be (100 x 100 pixels)

File Size:

Passport:*

SCRATCH CARD INFO

CARD PIN:*

CARD SERIAL:*

Declaration

I hereby declare that all the information provided by me in this admission form is true and accurate to the best of my knowledge. I understand that any false information provided may result in the rejection of my application.

I agree to abide by the rules and regulations of the school and understand that failure to do so may result in disciplinary action.

Agree to Term and Conditions

GLORY SUPREME SCHOOL

Student Admission Form