AQRAB MODEL SCHOOL (PRIMARY & PRE-SCHOOL)

AQRAB MODEL SCHOOL (PRIMARY & PRE SCHOOL) - Online Application

Pleas complete all sections
SECTION 1 - STUDENT'S PARTICULARS
Student Name *

First Name Last Name
Birth Date *

Month Day Year
MyKid Number *
Birth Certificate Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Age *
Gender *
Admission Level *
Admission Year *
SECTION 2 - MEDICAL HISTORY

(please tick and state the details if 'Yes' for any of below)
(a) Does your child have any allergies to
Medicine

Yes No
Details if 'Yes'
Immunization

Yes No
Details if 'Yes'
Food

Yes No
Details if 'Yes'
(b) Does your child have or had the following illness or problems
Asthma

Yes No
Epilepsy

Yes No
SECTION 3 - PARENT'S INFORMATION

(to be filled up by parent/guardian)
Father
Father Name

First Name Last Name
I.C Number
Highest Education
Occupation
Employer
Income
Office Number

Area Code Phone Number
Residential Number

Area Code Phone Number
Mobile Number

Area Code Phone Number
E-mail
Mother
Mother Name

First Name Last Name
I.C Number
Highest Education
Occupation
Employer
Income
Office Number

Area Code Phone Number
Residential Number

Area Code Phone Number
Mobile Number

Area Code Phone Number
E-mail
Guardian (if applicable)
Guardian Name

First Name Last Name
I.C Number
Highest Education
Occupation
Employer
Income
Office Number

Area Code Phone Number
Residential Number

Area Code Phone Number
Mobile Number

Area Code Phone Number
E-mail
SECTION 4 - DECLARATION
Additional Comments
Signature

Clear
Should be Empty:

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AQRAB MODEL SCHOOL (PRIMARY & PRE SCHOOL) - Online Application