Form Filler's Details Full Name (required) Relationship to the Applicant Your Email (required) Child's Info Upload Child's Passport (required) Child's Name [surname first] (required) Child's Pet Name Child's Date of Birth (required) Religion (required) —Please choose an option—ChristianityIslamOther Gender (required) —Please choose an option—MaleFemale Number of Siblings Position in the Family Home Address (required) Last School Attended (if any) Class Reason for Leaving Please attach last term's report sheet Background Information Father's Name (required) Occupation (required) Residential Address (required) Office Address (required) Phone Number (required) Additional Phone Number Email Address Mother's Name (required) Occupation (required) Residential Address (required) Office Address (required) Phone Number (required) Additional Phone Number Email Address Parents Living Together (required) YesNo Separated (required) YesNo Divorced (required) YesNo Single Parent YesNo Special Circumstance Custodial Information Who has legal custody of the child? Who collects the child after school daily? (Please inform the school if this changes) Hospital Details Name and Address of Family Doctor/Hospital Doctor's Phone Number Your Hospital Card Number Immunization History Please attach copy of immunization card Health Status Please state truthfully, your child's fitness for school Allergies (if any)(separate by commas) Other Health Conditions we need to know of, including those regarding e.g., Sight, Hearing, Feeling, etc Child's Developmental Level A Potty Trained Child is one that goes to the toilet by herself, pushes down her panties, wees and pulls her panties back up without assistance from an adult, or poos and calls out to an adult to come clean her up, and no longer has accidents weeing or pooing in her clothes. Is your child potty trained (required) —Please choose an option—YesNot Yet (*If your child is not potty trained, please pack 4 diapers or trainer pants in his/her bag daily.) Please give names and phone numbers of 2 people to call in case we can’t reach you in an emergency Name 1 (required) Phone Number (required) Name 2 (required) Phone Number (required) I declare that the information supplied by me is a true and accurate description of my child and his/her family situation. I agree that if in the future, while my child is in the care of Rubygates Preparatory School, any of this is found to be inaccurate, I may be asked to withdraw my child, and all fees paid forfeited. I declare that I am committed to making appropriate arrangement to collect my ward on time daily and within the daily grace period and agree that if I collect my ward later than the daily grace period, I should be billed for late collection based on my signed in collection time and to pay Late Collection Fees as and when due.
