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    Admission Form Format - Draft 2016

    Uploaded by

    Chaitanya Mullapudi
    This document is a registration and child information form for a school. It requests details about the child such as name, date of birth, gender, languages spoken, and previous schools attended. It also requests contact information for both parents. Additional sections gather health details like vaccinations, allergies, and medical history. The form aims to collect essential information about the child's background, family, health, and development to facilitate their enrollment and time at the school.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Admission Form Format - Draft 2016

    Uploaded by

    Chaitanya Mullapudi
    28 views4 pages
    This document is a registration and child information form for a school. It requests details about the child such as name, date of birth, gender, languages spoken, and previous schools attended. It also requests contact information for both parents. Additional sections gather health details like vaccinations, allergies, and medical history. The form aims to collect essential information about the child's background, family, health, and development to facilitate their enrollment and time at the school.

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    This document is a registration and child information form for a school. It requests details about the child such as name, date of birth, gender, languages spoken, and previous schools attended. It also requests contact information for both parents. Additional sections gather health details like vaccinations, allergies, and medical history. The form aims to collect essential information about the child's background, family, health, and development to facilitate their enrollment and time at the school.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    28 views4 pages

    Admission Form Format - Draft 2016

    Uploaded by

    Chaitanya Mullapudi
    This document is a registration and child information form for a school. It requests details about the child such as name, date of birth, gender, languages spoken, and previous schools attended. It also requests contact information for both parents. Additional sections gather health details like vaccinations, allergies, and medical history. The form aims to collect essential information about the child's background, family, health, and development to facilitate their enrollment and time at the school.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    Registration and Child Information Form

    PHOTO

    PARTICULARS OF THE CHILD

    Name: _______________ Surname: __________________ Nickname: _______________


    Date of Birth: ____________ (DD/MM/YY) Age: Years: _____ Months: ______ Days: _______

    Sex: Girl Boy Place of Birth: _____________________

    Language(s) spoken at home: Kannada: Hindi: Others (Please specify): _____________

    Nationality: ______________ Previous KG/Nursery/Creche Attended: _____________________________

    HOME DETAILS

    Father Mother

    Full Name _______________________________ ____________________________

    Home Address ________________________________________________________________

    ________________________________________________________________

    Occupation _______________________________ ____________________________

    Company Name _______________________________ ____________________________

    Mobile no. _______________________________ ____________________________

    Office no. _______________________________ ____________________________

    Res no. ___________________ E-mail Id: ____________________________

    ----------------------------------------------

    Siblings if any: Brothers: _______ Sisters: ___________

    Emergency contact no. (Other than parents): _______________________


    Child Birth Details

    Were there any complications in or during Pregnancy? ______________________________

    Normal delivery/C section _________________________________________

    How long was the child’s crawling period? _________________________________________

    At what age did the child first walk? __________________________

    At what age did the child first talk? __________________________

    Is your child toilet trained? __________________________

    Family Information: Married / Divorced / Separated / Joint Family / Adopted

    Does your child Watch TV/ DVD Yes No

    Estimated Watching Time (if Yes) ___________ Hrs. per day.

    Does your child use IPads/ Computers/ Electronic Games? Yes No

    Estimated usage Time (if Yes) ___________ Hrs. per day

    What is your understanding Waldorf Early childhood Education?

    ____________________________________________________________________________
    _
    Why Do you think Waldorf Education is suited to your child?

    ____________________________________________________________________________
    _

    Is there any Information about your child that you would like to share with the school?

    ____________________________________________________________________________
    _

    ____________________________________________________________________________
    _
    HEALTH DETAILS

    Vaccinations: (Please enter the dates below)

    a> BCG _________________ (Yes/No)

    b> DPT _________________ (Yes/No)

    c> OPV: _________________ (Yes/No)

    d> Measles _________________ (Yes/No)

    e> MMR _________________ (Yes/No)

    f> DT _________________ (Yes/No)

    g> HBV_________________ (Hepatitis 1, 2, 3) (Yes/No)

    h> H1 B _________________ (Meningitis -3 doses) (Yes/No)

    i>Chicken pox _________________ (Yes/No)

    j> Typhoid _________________ (Yes/No)

    k> Hepatitis A _________________ (2 doses) (Yes/No)

    Note: Vaccines (a) to (g) are compulsory; (h) to (k) are optional but recommended once a year.

    Past ailments, surgeries and illnesses: _______________________________________________________

    ______________________________________________________________________________________

    Allergies to any food / medicines: ________________________________________________________

    _____________________________________________________________________________________to any
    of the above Please specify treatment to follow

    Is your Child on any continuous medication?

    I DECLARE THAT THE INFORMATION GIVEN ABOVE IS CORRECT AND COMPLETE.

    Signature of Parent: ______________________ Date: ___________________________

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