PERSONAL RECORD FORM

Official Use Only

Registration No:
Student’s Picture

Date Admitted:

WESLEY GIRLS’ HIGH SCHOOL

STUDENT’S DETAILS:
First name: Middle name: Surname: Any other names used
Date Admitted:

Date of Birth: Place of Birth: Country:

Hometown: Region: Country:

NATIONALITY:

RELIGIOUS DENOMINATION:

Which language(s) can she read and write? Which language(s) can she speak?

SCHOOL(S) ATTENDED: Please list all the schools the girl has attended with dates.
Date: Name of School: Address: Class or Form:

FATHER’S DETAILS:
First name: Middle name: Surname: Occupation:

Postal Address: Tel No.(Office) Residential Address: Hometown:

Nationality:
Tel No. (Residence)
E-mail Address:

Father’s Signature: …………………………………. Date: …………………………

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MOTHER’S DETAILS:
First name: Middle name: Surname: Occupation:

Postal Address: Tel No.(Office) Residential Address: Hometown:

Nationality:
Tel No. (Residence)
E- mail Address:

Mother’s Signature: ……………………………………….. Date: ………………………….

GUARDIAN’S DETAILS :( Any person who can stand in for parents when they are not available)
First name: Middle name: Surname: Occupation:

Postal Address: Tel No.(Office) Residential Address Hometown:

Nationality:
Tel No. (Residence)
E- mail:

Relationship to student: …………………… Signature: ……………………………….. Date: ………………….

DETAILS OF PERSON SUPPORTING SCHOOLING OF STUDENT:

Postal Address: Tel No.(Office) Residential Address Hometown:

Nationality:
Tel No. (Residence)
E- mail:

Relationship to student:……………………………………Signature: ……………………………Date: …………………………..

NB.: PLEASE COME ALONG WITH COPIES

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 WESLEY GIRLS’ HIGH SCHOOL
MEDICAL HISTORY

1. Name of Girl:……………………………………………………………………………………………..................................................
2. Date of Birth: ……………………………………………………………………………………………………………………………..
3. Weight Now: ………………………………………………………………………………………………………………………………
4. Height Now: ………………………………………………………………………………………………………………………………
5. Does she suffer from:
Sickle-cell disease…………………………………………………………………………………………………………………………….
Rheumatism……………………………………………………………………………………………………………………………………..
Asthma…………………………………………………………………………………………….....................................................................
Fainting spells…………………………………………………………………………………….................................................................
Epilepsy…………………………………………………………………………………………..………………………………………………..
Mental disease………………………………………………………………………………………………………………………………….
Bedwetting……………………………………………………………………………………………………………………………………….
Please be truthful about this. If the school discovers that she wets her bed later after admission, her
boarding status will be reviewed.
Any other condition, which may need special attention ………………………………………………………………..
………………………………………………………………………………………………………………………………………………………….
6. Has she had any serious illness or operation at any time in her life?
If so, what………………………………………………………………………………………….…………………………………………….
and when…………………………………………………………………………………………………………………................................
From which doctor or hospital did she receive treatment?
……………………………………………………………………………………………………........................................................................
...................................................................................................................................................................................................................
7. Does she wear glasses? If so, what are the prescriptions?
………………………………………………………………………………………………………………………………………………………..
If not, can she see clearly to read from books and a classroom board? (Please take her to an optician if
there is any doubt about this).

8. Does she have any hearing impairment? If so, please describe the condition.
…………………………………………………………………………………………………………………………………………………
9. Has she had her teeth checked by the dentist recently?
……………………………………………………………………………………………………………….……………………………………..
(If not please check this)
10. Does she wear braces? .................................................................................................................................................................
If yes, how often does she have to see a specialist to have them adjusted?
………………………………………………………………………………………………………………………………………………………

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11. Can she eat normal school food? ..............................................................................................................................................
If not, please attach a medical certificate from a qualified doctor to say why not.

Is she allergic to any food? ..........................................................................................................................................................

12. Can she take part in all normal physical activities like sports, games, house cleaning etc.
..................................................................................................................................................................................................................
If not, please attach a medical certificate from a qualified doctor to say why not. Please note
that girls who for some reason cannot take part in any form of housework or cleaning will be
day students.

13. Does she have to take any medicine regularly including herbal medicine? If so, what, how often and
why.……………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………..
14. What medicines are you allowing her to bring to school?
………..…………………………………………………………………………………………………………………………………………….
.……………………………………………………………………………………………………………………………………………………..
15. Any other comment or information you would like us to know
……………………………………………………………………………………………………………………………………………………..
16. In case of severe illness or emergency please contact:
a. Name: ………………………………………………………………………………………………………………………....
Address: ………………………………………………………………………………………………………………………
Telephone Number (s):
Residence: …………………………………………………………………………………………………………………..
Office: ………………………………………………………………………………………………………………………….
E-mail Address: …………………………………………………………………………………………………………...
b. Name:……………………………………………………………………………………………………..............................
Address ……………………………………………………………………………………...............................................
Telephone Number (s):
Residence: ………………………………………………………………………………………………...........................
Office: ………………………………………………………………………………………………………………………..
E-mail Address: ………………………………………………………………………………………………………….
Date: ………………………………………………………………………………………………………………………….
17. I make this declaration conscientiously believing same to be true and correct.
Full name of Parent/Guardian……………………………………………………………………………………………..
Signature of Parent/ Guardian …………………………………………………………………………………………....

SPECIAL NOTE
Failure to disclose material information about the girl absolves the school from any liability arising
there from.
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 UNDERTAKING (WESLEY GIRLS’ HIGH SCHOOL)

ACCEPTANCE FOR ADMISSION UNDERTAKING

I ……………………………………………………………………hereby accept admission into

Wesley Girls’ High School and agree to be bound by the following conditions:

1. That l understand that the school is a Methodist Mission School with Methodist practices in which I shall
be expected to participate.

2. That I will obey all school rules and regulations.

3. That if I commit a breach of any school rule, I render myself to be disciplined in line with the school’s
disciplinary policies.

4. That I understand that the school is a place for moral training, development of talents, skills and awareness
of one’s responsibility to the community.

5. That I understand that my academic programme, pathways, subject combinations and year level can be
reviewed if my academic performance is consistently below standard.

6. That l will obey all to whom obedience is required.

7. That I understand that a breach of common sense is a breach of school rules.

8. I understand that I must always work hard to attain my full potential in all my subjects.

9. I have read this handbook in detail and I agree to abide by all the rules and the policies therein.

10. I agree that information provided the school can be shared with the Parent Association to assist
with students’ welfare. (Yes / No) (please tick yes if you agree to point 10)

Signature of student: ……………………………………………………………

Date: …………………………………………………………………………………………

I ………………………………………………………..........………………………

Parent/Guardian of ……………………………………………………………… declare that I

have read and understood the above undertaking and the Wesley Girls’ Students’ Handbook and that I accept
the terms and conditions for admission of my ward to Wesley Girls’ High School and will cooperate with
school authorities in their quest to give my daughter/ward a holistic education.

After the above has been read by (name of student) …………….……………… in the ………………...

Language and she seems to understand same before appending her signature or making his/her mark.

Signature of parent/guardian:

……………………………………………………………………………

Date: ………………………………………………………………………………………....