Apply Now – Benstel School System

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Child's Information

Name

First

Last

Date Of Birth

Age

Age as at date of applying

Sex

Male

Female

Birth Certificate Number

Religion

Hometown

Region

Grade From Last School Attended

Name Of Last School Attended

Mother's Information

Name

First

Last

Postal Address

Residential Address

Contact Numbers

Email Address

Name Of The Organisation

Employment details of mother

Designation

Please indicate your preferred method of contact

Father's Information

Name

First

Last

Postal Address

Postal address if different from mother

Residential Address

Residential address if different from mother's

Contact Numbers

Email Address

Name Of The Organisation

Employment details of mother

Designation

Please indicate your preferred method of contact

Health

Is your child on any medication? If so please give details

Is your child receiving any medical treatment? If so, please give details

Does your child suffer from any illness/allergies? If so, please give details

Does your child need any special care? If so, please give details

Is there anything else about your child we should be aware off?

Emergency Contacts

Name

Name of of 1st emergency contact

Relationship To child

Contact Address

Name

Name of of 2nd emergency contact

Relationship To child

Contact Address

This field should be left blank