(NEW STUDENTS ONLY) Independence City Primary School Pre-Registration Form

(NEW STUDENTS ONLY) Independence City Primary School Pre-Registration Form
Fill out the form carefully for registration
Mother's Name
First NameLast Name
Father's Name
First NameLast Name
Child's Name
First NameMiddle NameLast Name
Birth Date
MonthDayYear
Gender
Address
Street Address
Street Address Line 2
Town/CityParish
Postal / Zip Code
Is child fully immunized
Birth Certificate Number
Eg. EA2345
Last school attended by child
Telephone Number
Format: (000) 000-0000.
Additional Comments
Should be Empty: