Jawabu Registration Form

Emergency Contacts (Incase we are unable to reach you through the contacts above)
Name of person 1 & Relation to child*
Mobile Number*
Name of person 2 & Relation to child*
Mobile Number*
Medical Information
The school will provide a First Aid service during school hours and at school functions. It is essential, therefore that the school has up-to-date information about your child’s health and medical requirements. Please complete this form to the best of your knowledge.
Family Doctor Name
Family Doctor Phone Number
Do you have Medical Insurance?*

YesNo
Insurance/Health Coverage (Company)
Preferred Hospital*
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns or Psychiatrist counselling history.*

Enrollment History
Previous School 1
School Name
Location
Date Started

MonthDayYear
Date Ended

MonthDayYear
School Name
Location
Code Of Conduct
Other Information
Does the applicant have siblings?*
Please indicate their name and age.
How did you learn about Jawabu School
Please inform us of any other vital information you think we may need to know concerning the applicant.