ADMISSION FORM

Admissions Form (#6)

Student information
Guardian 1
Guardian 2
Emergency
Siblings
Previous school
Medical information

Guardian 1

Relation :

Father

Mother

Other

Relation (if other) :

Guardian Name :

Guardian Name (in Arabic) :

Email Address :

Landline :

Mobile Number :

Paper information :

Official Document :

National ID

Passport

National ID :

Passport number :

Educational degree :

Occupation :

Organization :

Emergency Contact 1 :

First Name

Last Name

Relationship :

Landline :

Mobile number :

Emergency Contact 2 :

First Name

Last Name

Relationship :

Landline :

Mobile number :

Previous School Information :

School's Name :

From Date :

To :

Country :

Medical Information :

Date of Birth

In order to keep an updated medical record of your child , Kindly answer the following questions :

Allergies type

Other medical problems

Yes

Medical problems type

Did your child have any of the following vaccines?

	Yes	No
Polio شلل الاطفال
MMR الحصبة / الحصبة الالماني / الغدة النكافية
DPT or (DT) الثنائي البكتيري / الثلاثي البكتيري
Chicken Pox الجديري المائي
Meningitis الالتهاب السحائي

If your child suffers from any condition, would you please list which medications he/she requires :

Does your child have difficulty in hearing ?

Has your child ever been hospitalized ?

Yes

Kindly state the reason:

Has your child ever undergone any surgical operations ?

Yes

Kindly state the reason:

Does your child suffer from any medical condition that would prevent him/her from participating in physical education programmes?

Yes

Kindly state the reason:

IMPORTANT: if you don't receive an autoreply, kindly send an email to ykhattab@svs.edu.eg

Adress

Cairo-Alex
Desert Road, Sixth of October, B149,Smart Village, Km 28, Egypt

Phone Numbers

+20 235370100/200

+20 235370135

E-mail

Kiplingschool@svs.edu.eg

	Yes	No
Asthma
Diabetes
Epilepsy
Eczema
Allergies (ex. Certain drugs, food, others..)

ADMISSION FORM

Nursery Information :

Student information :

Guardian 1

Paper information :

Guardian 2 :

Paper information :

Parent status :

Emergency Contact 1 :

Emergency Contact 2 :

Siblings information :

Previous School Information :

Medical Information :

In order to keep an updated medical record of your child , Kindly answer the following questions :

Adress

Phone Numbers

E-mail