Little Feat Montessori House of Children

Little Feat Montessori House Of Children
Admission Form

AF #. _____________

Date: _________________________

Student Data

Name:

______________________________________

Date Of Birth:

________________

Nationality:

________________

Mother Tongue:

____________________________

Language(s) Spoken:

______________________________________

Recent Photograph

Family:

Name

Occupation

Father:

________________________________ ___________________________

Mother:

________________________________ ___________________________

Guardian:

________________________________ ___________________________

Brother(s):

Age

1.

______________

2.

______________

School:

_________________________________________

Sister(s):

Age

1.

______________

2.

______________

School:

_________________________________________

Family Address:

Telephone:

__________________________

Email:

__________________________

Other Student Information

1. Previous Illness/allergy, if any

a.

b.

c.

2. Special Dietary Restrictions, if any.

3. Have all routine immunizations been given?

Yes No

4. Any previous school attended Name // Year

a)______________________________________________ //___________________

Office Use:

Recd Date ________________________________

Recd By __________________________________

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