PUPIL APPLICATION FORM – Complete using block letters
Section 1 - Particulars of student:
Surname:First Name(s):Gender MaleFemale

Date of birth:

Age:

Place of birth:

Country ofbirth:
HomeVillage:

District of origin:

T/A:

Place of residence:

Religion:

Nationality:
Yes

No

If yes,pleasespecify:

Any disability?

Previous school(s) attended:
School name:

School address:

School name:

School address:

Which standard
are you applying Standard 1for?

Standard 2

Standard 3

Standard 4

If you are a Roman Catholic, please provide the following details:
Baptism Date:

ParishName:Baptism
Place:

Confirmation Date:

Baptism
Number:Parish Priest’s
Name:

Confirmation Place:

Parish Priest’s
Signature:

Confirmation Number:
Parish Stamp:

Section 2: Other Information
Allergies: If your child has any allergies please specify use a separate sheet if necessary:Special Medical Requirements. Please provide fulldetails – use a separate sheet if necessary:
Does the pupil have brothers or sisters who are also applying to Carlo Acutis HighSchool? If so, give their names.

Does the pupil have brothers or sisters who are applying to St. Kizito PrimarySchool? If so, give their names.
Does the pupil have brothers or sisters who are at or are applying to Mother Teresa Children’sCentre? If so, give their names.

Section 3: Particulars of Parents/Guardians
Parent / Guardian

Emergency Contact Details – to be contacted ifparent or guardian cannot be contacted:

Surname:

Surname:First
Name(s):First
Name(s):Address:

Address:

Occupation:

Occupation:

Email Address:

Email Address:

Phone (1)Phone (1)Phone (2)Phone (2)Nationality

Nationality

Relationship toStudent:

Relationshipto Student:

Section 4: Declaration by Parents/Guardian
I agree that he/she will abide by all the rules and regulations of the school as specified;
I understand that attendance at all school events and activities is compulsory;
I accept responsibility for ensuring that fees are paid before school opening each term and before the end of each month;
I understand all medical and other information which may be relevant to my child’s development and safety at school, must
be communicated to the school;
5. I agree that in my absence, the Head teacher and staff shall act on my behalf as a parent/guardian with regard to my child;
6. I agree that records are to be kept on my child for the purpose of my child’s development and support;
7. I agree that photographs/videos may be taken of my child for purposes of the school, e.g., website, advertising, etc.
8. I agree that my child may be taken on trips outside of school premises during normal school hours;
9. In the event of a medical emergency, we will attempt to contact parents/guardian. If this is not possible, the Head Teacher(or a designated substitute) will give their consent for the treatment of my child by a medically qualified practitioner;
10. I certify that all the information given in this form is correct.
I understand that failure to comply with any of the above may lead to the suspension or exclusion of my child.
1.
2.
3.
4.

Signed:Print Name:

Additional Notes:
Bring this completed registration application form to the school with:
1. 2 Passport size photos of your child.
2. A copy of your child’s most recent School Report.
3. A letter of recommendation from your Priest, Pastor or Religious leader.
If your child is accepted into the school, termly Fees are K225,000 50% must be paid before start of each term; theremainder to be paid in two equal instalments at the start of the following two months.