Child Registration Form

QINS ADMISSION FORM

Child's Full Name

Child's Date of Birth

Child's Place of Birth

1st Parent's/Guardian's Name

1st Parent/Guardian Phone Number

Email

Postal Address

Place of work

2nd Parent/Guardian Name

2nd Parent/Guardian Phone Number

Email

Postal Address

Place of work

Child Residence Details
LC

Parish

Zone

Emergency Phone Number

With whom does Child live?

Name of Family Doctor

Doctor Phone number

Is Child a special needs?

If Yes, give details of health complications

Attach birth Certificate

Attach Passport-sized Photo

Attach Child Immunization card