Enrolment Form
Child’s full name: __________________________________________________
Address: _______________________________
_______________________________ Date of birth: _______________
_______________________________ Religion: _______________
Tel no: _____________________ No of children in family: _______
P.P.S no. _______________________
Mobile no’s: ________________________ ________________________
Names of parents / guardians:
1.__________________________________ 2.__________________________________
Daily contact no(s), if different from above: 1.______________________________
2.______________________________
Parents occupations: (for departmental records only) ______________________________________
______________________________________
Medical history (any illness, asthma, disability, visual auditory or language problems, allergy, etc.)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Emotional / behavioural conditions
___________________________________________________________________________________
__________________________________________________________________________________
Emergency contact names and numbers: (in the event of your child being ill during school hours)
1.___________________________ 2.___________________________
Food: special diet or relevant information:
___________________________________________________________________________________
___________________________________________________________________________________
Family doctor:__________________________________________________
Please complete the following general information
1=Always: 2= Usually: 3 = Sometimes: 4 = Seldom: 5 = Never
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Please put an X in the box you consider best describe
your child in each case
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1
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5
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1. Speaks clearly
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2. Helps with activities in the home.
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3. Carries on simple conversation.
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4. Is independent of parents / guardians.
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5. Goes to toilet by himself / herself.
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6. Is shy when he / she meets unfamiliar children.
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7. Is shy when he / she meets unfamiliar adults
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8. Is easily upset.
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9. Is aggressive when he meets unfamiliar children.
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10. His / her attention jumps easily from one thing to another.
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11. Is subject to temper - tantrums
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12. Is extra – talkative.
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Anything else we should know about your child
____________________________________________________________________________________________
Parents signature: _____________________________
_____________________________
Date: _______________