Read-only Browsing: Please complete the first section of the form in order to edit subsequent sections.
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Name (As in Passport)

Sibling Information

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Parent/Guardian

Home Address GZ

Employer’s Address

Parent/Guardian

Home Address GZ

Employer’s Address

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Emergency Contact

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Background Information
Student’s Language Profile

Parent/guardian’s assessment of child’s fluency in English. (Please select the box as applicable to your child.)

Parent/guardian’s assessment of child’ s fluency in other languages. (Please select the box as applicable to your child.)

Student’s Previous Schools

School Year

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Student’s Special Educational Needs
Student’s Medical Information

Note: If you wish school nurse to administer medication during school hours, please send a note with t he student’s name, the reason for giving the medicine, dosage, time and for how many days. Students must not administer their own medication, unless permission has been granted by the parent/guardian.

Your child will be taken to the nearest medical facility if emergency treatment is required unless the parent/guardian requests otherwise. Please provide an emergency contact details if necessary.

Immunization Record

Or select the relevant information in the following questions.

Measles/Mumps/Rubella

Dates

Diphtheria/Pertusis/Tetanus

Dates

Haemophilus Influenza B (Hib)

Dates

Tuberculosis (BCG)

Dates

Hepatitis B

Dates

Chicken Pox

Dates

Polio Vaccine

Dates

Tuberculin Test

Dates

Other

Dates