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KINDERGARTEN REGISTRATION

Academic Session
academic session month*
academic session month*
Class applied for:
Applicant's General Information
Full Name:*
Alias:
Sex*
- Male
- Female
Age:*
Date of birth*
Date Format: MM slash DD slash YYYY
Religion:
Nationality:*
Place of Birth:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Picture of the applicant*
Mother
Name:
Home Phone:
Work Phone:
Email:
Place of Employment:
Name of Employer:
Father
Name:
Home Phone:
Work Phone:
Email:
Place of Employment:
Name of Employer:
Other
Name:
Relationship:
Home Phone:
Work Phone:
Email:
Place of Employment:
Name of Employer:
Emergency Contact Person
Name:*
Phone number:*
Email:
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Medical information
Name of Doctor:
Phone number:
Medical History:
Allergies:
Any other challenges:
Payment Plans:
- Full (Prior to the beginning of the new school term. All receipts should be in on the first day of school)
- Half (Prior to the beginning of the new school term. All receipts should be in on the first day of school. The second half should be paid by the second week post to the start of the new term. All receipts should be in by the third week of school.)
**ALL fees are payable at the Antigua Commercial Bank, Thames Street. Acct # 0311531050, or via the ACB Mobile App or the St. Peters Academy Website.
Placement test score:
House Assigned:
Signature of Applicant:
Date
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

KINDERGARTEN REGISTRATION

Academic Session

Applicant's General Information

Mother

Father

Other

Emergency Contact Person

Medical information

Payment Plans: