REGISTRATION FORM - International English School Of Abidjan

INTERNATIONAL ENGLISH SCHOOL OF ABIDJAN
Rue J71-II Plateaux Vallon, Cocody
08 BP 1828 Abidjan 08- Côte d’ivoire
Fixed Telephones: 22.41.72.17 (CI Telecom)/21.01.44.59 (MTN)
Cell. Telephones: 05.99.62.83/49.92.51.38/66.37.30.65/45.57.78.54/06.17.37.31
E-mail: [email protected]/Website:www.iesaci.com
REGISTRATION FORM
DATE OF ADMISSION:
ADMISSION NUMBER:
STUDENT'S SURNAME:
STUDENT'S FIRST NAME:
MIDDLE NAMES:
DATE AND PLACE OF BIRTH:
NATIONALITY:
AGE:
LEVEL:
RESIDENTIAL ADDRESS:
INDICATION:
TELEPHONE:
FATHER'S NAME:
FATHER'S BUSINESS ADDRESS:
TEL:
E-MAIL:
MOTHER'S NAME:
MOTHER'S BUSINESS ADDRESS:
TEL:
E-MAIL:
EMERGENCY CONTACT (NEAREST RELATIVE OR FRIEND)
NAME :
ADDRESS :
TEL:
Affiliated to the Qualifications and Curriculum Development Agency (QCDA) in U.K.
RCCM N°CI-ABJ-2009-B-4295/CC N°0912861 X/CNPS N°220463
NAME, ADDRESS AND TELEPHONE NUMBER OF ANY PERSON OTHER THAN PARENTS WHO ARE
AUTHORIZED TO PICK UP CHILD FROM SCHOOL.
1.
2.
3.
MEDICAL EMERGENCY
I hereby give permission to:
(Name of school)
To take my child
(Name)
To a hospital for medical treatment when I cannot be reached or when delay
would be dangerous.
(PARENT’S SIGNATURE)
(DATE)
INTERNATIONAL ENGLISH SCHOOL OF ABIDJAN
Rue J71-II Plateaux Vallon, Cocody
08 BP 1828 Abidjan 08- Côte d’ivoire
Fixed Telephones: 22.41.72.17 (CI Telecom)/21.01.44.59 (MTN)
Cell. Telephones: 05.99.62.83/49.92.51.38/66.37.30.65/45.57.78.54/06.17.37.31
E-mail: [email protected]/Website:www.iesaci.com
CHILD’S DOCTOR (PAEDIATRICIAN)
NAME
:
ADDRESS
:
TELEPHONE :
CHILD’S SCHEDULE AND INTERESTS
The following information will assist us to understand and care for your child.
Please describe child’s eating habits ― food likes and dislikes food allergies, infant
schedule and formula.
Describe the play activities that your child likes - both indoors and outdoors.
THIS SECTION CONCERNS A CHILD AT PRESCHOOL LEVEL
Describe your child toilet and hygiene habits. (Can he/she use the toilet alone ―wash
hands, etc?)
Affiliated to the Qualifications and Curriculum Authority (QCA) in U.K.
RCCM N°CI-ABJ-2009-B-4295/CC N°0912861 X/CNPS N°220463
Does your child have allergies (If yes, please specify)?
Is there any other special information that is important to your child's care?
(PARENT’S SIGNATURE)

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