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SERWAA BOATENG MEMORIAL SCHOOL

Motto: EDUCATION IS LIFE

Location: KONONGO | Contact: 0240813126

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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 (Tick One)

School Bus Will Trek Own Vehicle

House: Room:

OTHER INFORMATION

Name of First Person to Pick: Relation: Tel:
Name of Second Person to Pick: Relation: Tel:

PARENT/GUARDIAN INFORMATION

Father/Guardian Name: Contact:
Mother Name: Contact:

MEDICAL INFORMATION

Allergies (Tick One): Yes No
Special Medical Conditions:
NHIS No:

DECLARATION BY PARENT/GUARDIAN

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

Date of Registration: ____________________