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  • Southborough Primary School

  • 1A Augusta Drive

    Independence City, St. Catherine

    Jamaica, W.I.

    Email: southboroughprimary@yahoo.com

  • APPLICATION INFORMATION

  • ENTRANCE INFORMATION

  • Date :*
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  • Estimated Entrance Date*
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  • STUDENT INFORMATION : PERSONAL

  • Date of Birth :*
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  • Nationality

  • Past School Information

  • Date started :
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  • Date ended :
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  • Parents Data

  • Please indicate which parent details to be recorded :*
  • Father's Information

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  • Mother's Information

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  • Emergency Contact Information

  • Please note that in the case of an emergency, the parents will be called first. If no contact can be established with either parent, the school will make contact with the emergency contacts listed below in order of their names.

  • Date
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  • MEDICAL HISTORY

  • Does the student suffer from any of these illnesses: (Check all that apply)
  • Has the child ever had any surgical operations:*
  • Has your child ever been diagnosed with the following ?

  • Depression :*
  • Learning Disability :*
  • Hyperactivity (ADHD) :*
  • Behaviour Disorder :*
  • Has your child experienced any of the following ?

  • Recent stress eg, death or relocation of a close family member, relative or friend : *
  • Difficulty making friends, and/or adjusting to new situations :*
  • Difficulty concentrating in class :*
  • History of fighting/hurting others :*
  • Who is the head of the household ?*

  • What method do you use to discipline your child ?*
  • Do you plan to send your child to university ?*
  • With whom does the student live?*

  • APPLICANT INFORMATION

  • Applicant's (Person who is filling out this form) Relationship to Student:*
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  • I HAVE READ AND UNDERSTOOD THE QUESTIONS ASKED ABOVE AND ANSWERED ALL THE QUESTIONS TRUTHFULLY. *
  • Should be Empty: