LEMMY’S COURT INTERNATIONAL SCHOOL
ADDRESS: P.O.Box cs 8998
Location: Afienya, Rice city
Telephone: 0244204905
REGISTRATION FORM
Application Submission Date: Passport Picture
Date of Commencement: __ __ /__ __/__ __ Grade Entering: ______
Student Information
PERSONAL DETAILS:
Student Name: (Order: Last name, first name, and other names)
_______________________________________________________
Date of Birth: Place of Birth: ______________________________
Mother Tongue: Religion: __________________________________
House Address: Nationality: ________________________________
Other Languages spoken:_______________________________________________________________
Previous School Attended (please provide a copy of certificate):________________________________
____________________________________________________________________________________
Location: Class: ___________________________________
Medical Information
Does your ward any medical condition we need to be aware of?
No Yes
If yes, please specify: __________________________________________________________________
____________________________________________________________________________________
Note: Please provide accurate and complete information about your child’s medical conditions (e.g.,
asthma, allergies, diabetes, epilepsy, etc.) that may affect their participation in school activities or
require special care. This helps the school ensure your child’s safety and well-being.
Parent or Guardian Contact Information
Parent/ Guardian name: ________________________________________________________________
Home phone: ___________________________ Work phone: _________________________________
Residential Address: _____________________ WhatsApp number: ____________________________
E-mail: _______________________________ Employer: ___________________________________
Emergency Contact name: ______________________________________________________________
Emergency contact number: ______________________ Alternate phone:________________________
NOTE: We kindly ask that you review the information provided on this registration form
carefully before submission. Accurate and complete details especially regarding your child’s
medical history, emergency contacts, and special needs are essential for us to provide a safe,
supportive, and responsive learning environment. All information shared will be treated with
the strictest confidentiality and used solely for educational, health, and administrative
purposes. Should there be any changes in your child’s health, contact information, or family
circumstances during the school year, it is your responsibility to notify the school promptly. By
signing this form, you confirm that the information provided is true and correct to the best of
your knowledge. Your cooperation is greatly appreciated in helping us care for and support
your child throughout their time at school.
Office Use only
Student Name: (Order: last name, first name, other names)
_______________________________________________________________________________
Guardian Name: (Order: last name, first name, and other names)
TYPE PERSONAL NAME
_______________________________________________________________________________
Admission number: _______________ Admission Granted? Yes No
Date of Admission: __ __/__ __/__ __ __ __
Administrator Signature: Director Signature
_____________________ ______________________
TYPE PERSONAL NAME
