Student Registration / Admission Form

Please complete this form clearly in BLOCK LETTERS where applicable.

1. Academic / Admission Information

Academic Session:

Class:

Admission Number:

Admission Date:

2. Student Personal Information

Full Name:

Gender: Male Female

Date of Birth:

Place of Birth:

State of Origin:

LGA:

Phone Number:

Email Address:

PASSPORT
PHOTOGRAPH

3. Residential Information

Residential Address:

4. Father's Information

Father's Name:

Phone:

Email Address:

5. Mother's Information

Mother's Name:

Phone:

Email Address:

6. Guardian / Next of Kin & Emergency Contact

Guardian / Next of Kin:

Relationship:

Emergency Contact:

Phone:

Guardian Address:

7. Declaration

I hereby declare that the information provided on this form is true, complete and accurate to the best of my knowledge. I understand that any false or misleading information may affect the student's admission or school record.

Student's Signature

Parent / Guardian Signature

Date

8. For Office Use Only

Student Status:

Payment Status:

Admission No.:

Initial Password:

Date Received:

Checked By

Administrator's Signature

Date