MILLICENT ACADEMY JUNIOR SCHOOL

STUDENT REGISTRATION FORM

Pre-School to Grade 7 | New Learners Accepted: Pre-School to Grade 6

Registration Fee is Non Refundable

+266 5621 6139 millicentacademy@gmail.com info@millicentacademy.org.ls www.millicentacademy.org.ls

Personal Details

First Name *

Middle Name

Last Name *

Date of Birth

Gender *

Male Female

Religion

Phone

Email *

Village

District

Country

Admission Details

Student Type *

Class *

Does the child have any health conditions, allergies, or special needs?

Parent / Guardian Details

Parent's Name *

Parent's Phone *

Parent's Occupation

Parent's ID Number

Guardian's Name (if applicable)

Guardian's Phone

Relationship to Child

Guardian's ID Number

Alternative Contact Person

Name

Phone

Relationship to Child

ID Number

Proof of Payment

Upload Proof of Payment *

Accepted: PDF, JPG, JPEG or PNG. Max 5 MB.

Required Attachments

Please attach the following documents as proof of registration:

Copy of the child's birth certificate *

Accepted: PDF, JPG, JPEG or PNG. Max 5 MB.

Copy of parent/guardian ID *

Accepted: PDF, JPG, JPEG or PNG. Max 5 MB.

Previous school report

Accepted: PDF, JPG, JPEG or PNG. Max 5 MB.

Declaration & Signature

I/We, the parent(s)/guardian(s) of the above-named learner, hereby confirm that all information provided in this form is accurate and complete. I/We understand that any false information may result in the cancellation of this registration. I/We agree to abide by the rules and regulations of Millicent Academy School.

Parent/Guardian Signature (full name) *

Date *