ASSEMBLIES OF GOD EDUCATIONAL COMPLEX

Motto: GREAT AGECO……. THE AMBASSADORS

KONONGO | Tel: 0593988400

ADMISSION FORM

BASIC INFORMATION

First Name:

Other Name:

Surname:

Gender:

Date of Birth:

Previous School:

Reason(s) for Leaving Previous School:

Previous Class:

Class Admitted:

Residence Type:

FEES TYPE (Tick One)

FULL SCHOLARSHIP

HALF SCHOLARSHIP

BURSARY

REGULAR

PECULIAR

PECULIAR 1

PECULIAR 2

PECULIAR 3

NO FEEDING

NTNF

Canteen DB

3RD CHILD

4TH CHILD

5TH CHILD

OTHER

HOUSE AND TRANSPORTATION

Mode of Transport: School Bus Will Trek Own Vehicle

House:

Room:

PICK-UP & GUARDIAN INFORMATION

Father/Guardian:

Contact:

Mother Name:

Contact:

1st Pick Person:

Relation:

Tel:

2nd Pick Person:

Relation:

Tel:

MEDICAL INFORMATION

Allergies: Yes No

NHIS No:

Special Medical Conditions:

DECLARATION

I, Mr./Mrs./Miss solemnly declare that:

All entries above are correct to the best of my knowledge.
My ward will obey all rules and regulations of the school.
I will be responsible for all my ward's bills.

Signature:

Date: