Application – Riviera High School

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Class to which admission is sought (Select) REB Senior:

Class to which admission is sought (Select) CIE Year :

Class to which admission is sought (Select) Other BTEC:

SAT

Language Class

STUDENT DETAILS (Please fill in block letters)

Student’s Family Name:

Student’s First name:

Other Names

Gender: M / F

Date of Birth:

MM slash DD slash YYYY

Nationality:

Religion:

LAST SCHOOLS ATTENDED

1. Name of School :

Classes attended:

Address:

From which Year to which Year?

2. Name of School :

Address:

Classes attended:

From which Year to which Year?

Has this child ever been suspended or expelled from school? Yes/No

If yes, when & why?

NB: Any discipline problems at the previous school must be declared and discussed. FAILURE TO MAKE A COMPLETE DECLARATION ENTITLES RIVIERA HIGH SCHOOL TO EXCLUDE THE STUDENT AT ANY TIME.

FAMILY CONNECTIONS TO THE SCHOOL

The student’s sibling(s) is currently at Riviera High School? Name & Class:

The student had a former sibling enrolled in the past? Name & Years:

The student’s parents were former students of the school? Name & Years:

The student’s parent is a member of the Advisory Council ? Name:

FAMILY INFORMATION (Father/Guardian Primary Care Giver Contact Details )

Name

Street Address

Village/Umudugudu

Cell/Akagali

District

Occupation

Telephone (Mobile/Home)

Telephone (Work)

E-mail

Postal Address

Town

FAMILY INFORMATION (MOTHER/Guardian Primary Care Giver Contact Details )

Name

Street Address

Village/Umudugudu

Cell/Akagali

District

Occupation

Telephone (Mobile/Home)

E-mail

Postal Address

Town

OTHER CONTACT PERSONS

Full name (Mr./Mrs./Ms/Miss/Dr/Rev)

Home Phone:

Mobile:

E-mail:

Occupation:

Work phone number:

Residential Address:

Number/Street:

Suburb:

Town:

Post Code:

EMERGENCY CONTACT DETAILS

Full name (Mr./Mrs./Ms/Miss/Dr/Rev)

Home Phone

Mobile:

E-mail:

Occupation:

Work phone number:

Residential Address:

Number/Street:

Suburb:

Town:

Post Code:

Who is responsible for paying the student’s school fees? (Tick)Father/Mother/Guardian/NGO/Parent’s Employer If fees are paid by Guardian, NGO or Parent’s Employer, please give details below:

Name:

Relationship:

Postal Address in full:

Contact Person:

Telephone:

I declare that the information given on this form is correct and true. I permit my child’s full participation in all the activities included in the school curriculum. I accept to pay all fees and dues before the student joins the school and before the start of each term. I have read and understood the school rules including the major disciplinary sanctions.

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