SHALOM CHRISTIAN COLLEGESHALOM CHRISTIAN COLLEGEGRACELAND,NIHORT/SONSO ROAD,OFF IDI-ISHIN ESTATE,IBADAN, OYO STATE,NIGERIA.

Tel: 080832181970802324410208034447808

E-mail: shalomschools009@gmail.cominfo@shalomchristianschools.com

Website: www.shalomchristianschools.com

STUDENTSTUDENTAPPLICATION FORMAPPLICATION FORM

SURNAME FIRST NAME OTHER NAMES

NAME OF STUDENT

GRADE/CLASS AND YEAR OF APPLICATION

DATE OF BIRTH

GRADE/CLASS YEAR

DAY MONTH YEAR

PHOTOGRAPH OF STUDENT

Accession No.:

Family Code:

Notes:

Admission Secretary

Documentation to be enclosed:

<2x ID Photographs

<A certified copy of Parents’/Guardian’s ID Documents

<A certified copy of Child’s Birth Certificate

<Previous Reports, if applicable

<Registration Fee paid

<Staff (Shalom Christian Schools)

<Sibling(s) at Shalom Christian N/P School

<Sibling(s) at Shalom Christian College

<Foreign Student (copy of Entry Visa/Study Permit)

<Missionary Kid

FOR ADMIN PURPOSES ONLY:

MEDICAL BACKGROUND INFORMATION

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_________________________________Family Doctor Dr. Tel:

Family Dentist Dr. Tel:

Eye Test Date: Hearing Test Date:

Additional Information:

The College undertakes to contact the parent/s or guardian in the event of any emergency. However, in the event of an emergency, I/We give my/our consent to the College taking whatever steps may be deemed necessary for my/our child/ward:

Print Name: Print Name:

Signature: Signature:

Are all fees paid up at the previous school? Yes No

ACCOUNTS: PLEASE TICK APPLICABLE BOX) Post E-mail Both

EMAIL ADDRESS, FOR ACCOUNT PURPOSES:

POSTAL FOR ACCOUNTS: (IF DIFFERENT FROM POSTAL) ____________________________________

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REGISTRATION FEE – Payment of ? ________________, has been made. I understand that this Registration

Fee is non-refundable whether or not my application to have my child/ward accepted at Shalom Christian College (SCC) is successful.

ADMISSION FEE – On offer of admission, an admission fee will be paid, which guarantees a place for your child/ward in the College. All fees however, must be paid on or before the first day of the term.

Dated at ________________________________ this _________ day of ____________________, 20______

Signed: ____________________________________________________________(PARENT / GUARDIAN / OTHER) WHOSE LIABILITY IN TERMS HEREOF SHALL BE JOINED AND SEVERAL.

This application is accepted on behalf of the College _____________________________________________

Designation _______________________________ Signature/Date _____________________________

ACCOUNTS

APPLICATION FORM

PERSONAL PARTICULARS OF STUDENT:

FAMILY MEMBERS WHO HAVE ATTENDED / ARE ATTENDING SHALOM CHRISTIAN COLLEGE:

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FURTHER PARTICULARS OF STUDENT

Personal Details

FATHER'S/GUARDIAN'S DETAILS MOTHER'S/GUARDIAN'S DETAILSPlease include with your application form:

1) Certified copies of both parents'/guardian's Identity Documents

2) Certified copies of the Student's Birth Certificate

3) 2 x ID photographs of the Student

I/We, (Dr, Mr, Mrs, Chief, Engr., Arc. etc) ______________________________________________________

_______________________________________________________________________________ (father)

______________________________________________________________________________ (mother)

the undersigned, in my / our capacity/ies as Parent(s) / Guardian(s) / Custodian(s) / Other – (please specify):

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of: SURNAME (block letters): herein after referred to as the student _________________________________

FIRST NAMES in full: ____________________________________________________________________

or _______________________________, name by which the Student is called, hereby apply for in terms of clause 3 of the Conditions of Enrolment of Students to SHALOM CHRISTIAN COLLEGE, (conditions are set out overleaf) for the enrolment of the said Student as a Boarder/Day Scholar (please circle) at SHALOM CHRISTIAN COLLEGE.

Home Language/s:

Date of Birth: Place of Birth:

Nationality:

State of Origin: Religious Denomination:

Name of Student's Previous School:

Previous School Tel. No.:

Grade/Class completed or partly completed at date of leaving last school:

(Please attach recent report)

Has student ever repeated a grade/class? Yes No How many times?

Any individual characteristics, disability or difficulty to which attention is drawn: Parents are obliged to give an honest account of all remedial therapy/ therapies which the student has undergone or required. This includes occupational therapy, speech therapy, medical treatment for any medical condition or any other relevant information. Kindly attach copies of all relevant reports in this regard.

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Position in family 1 2 3 4 5 6

Name: __________________________________________ From: ___________ To: ____________

Names and ages of siblings (i.e. brothers and sisters) ____________________________________________

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Has the child ever suffered from: Yes/No Comment

MEDICAL HISTORY: Please list all illness, operations, serious accidents and infectious diseases

EMERGENCY CONTACTS (e.g. Grandparents, family friend, etc.) RELATION TO STUDENT

Surname:

Name: Name:

Title: Title:

Initials: Initials:

National ID Number: National ID Number:

Company: Company:

Occupation: Occupation:

Home Phone: ( ) Home Phone: ( )

Business Phone: ( ) Business Phone: ( )

Father Cell: Mother Cell:

Father e-mail: Mother e-mail:

Postal Address: Postal Address:

Physical Address: Physical Address:

Where parents are divorced or separated, or if other special circumstances prevail, please provide further relevant details/instructions (if any):

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1. Name:

Phone:

2. Name:

Phone:

3. Name:

Illnesses*, operations, accidents Date Permanent consequences, if any

1.

2.

3.

*including particularly rheumatic fever, malaria, bilharzia, diabetes

Migraine

Bed Wetting

Heart Disease

Chest Disease

Rupture/Hernia

Convulsion

Asthma

Any Allergy

Any other condition which requires special consideration

Surname:_____________________________________________________

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