Online Application form

GENDER
Male Female

DOB

FATHER

MOTHER

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In event of an emergency, JRJ Excellence Academy School should contact :

CONTACT #1

CONTACT #2

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You are required to complete this section

CHILD'S PREVIOUS SCHOOL DOCUMENT

CHILD'S PASSPORT PHOTOGRAPH

CHILD'S BIRTH CERTIFICATE

CHILD'S IDENTITY CARD

CHILD'S IMMUNIZATION RECORD

PASSPORT PHOTOGRAPH (PARENT/GUARDIAN)

PASSPORT PHOTOGRAPH (PARENT/GUARDIAN)2

IDENTITY CARD (PARENT/GUARDIAN)1

IDENTITY CARD (PARENT/GUARDIAN)2

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ATTESTATION

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HEALTH RECORDS

ANY SPECIAL HEALTH PROBLEMS? IF YES, SPECIFY

PHISICAL DISABILITY (IF ANY)

DO YOU OBJECT TO TRANSFUSION?

Yes No

DO YOU HAVE ALLERGIES?

Yes No

IF YES PLEASE LIST

IMMUNIZATION IN THE PAST TWO YEARS

ATTESTATION

By clicking save you certify that information given above is true to the best of your knowledge.

Save & Submit

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