Mind Builders Schools :: Building The Future

Mind Builders School

...Building your child for tomorrow's challenges

Apply to High School

Required Fields are starred (★)

Student Details

★ Surname:

★ Other Names:

★ Gender:

★ Date of Birth:

Age: year(s).

Place of Birth:

★ Religion:

Student's Phone Number:

Student's Email Address:

Weight:

Height:

Metres

★ Residential Address:

Home Phone Number:

★ Nationality:

State of Origin:

Local Govt. Area:

★ Class for which Admission is sought:

★ Year and Month of Proposed Entry:

(e.g. 2018 September or 2019 January or 2020 April)

★ Photo of Student:

Future Ambition:

Hobbies & Sporting Interests:

Father's Information

Father's Full Name:

Father's Occupation:

Name and Address of Employer:

Father's Contact Phone:

Father's Email:

Mother's Information

Mother's Full Name:

Mother's Occupation:

Name and Address of Employer:

Mother's Contact Phone:

Mother's Email:

Guardian's Information

Guardian's Full Name:

Guardian's Contact Phone:

Guardian's Email:

Guardian's Address:

Guardian's Relationship to Student:

Fees Correspondence

(This should only be filled, if accounts are not to be sent to Parents or Legal Guardians above. Else, leave blank)

Name:

Relationship to Student:

Address:

Phone:

Email:

Student's Health Record

Please, Specify any Injuries or Medical Conditions the Student has that require Special Attention (if none, leave it blank):

★ Blood Group:

★ Genotype:

Allergies (if none, leave it blank):

★ Family Hospital Name:

★ Family Hospital Contact Phone:

★ Family Hospital Address:

★ Doctor in Charge:

Emergency Contact Inforation

★ Emergency Contact Name:

★ Emergency Contact Phone:

★ Relationship to Student:

★ Emergency Contact Address:

Educational Background: Primary School

★ Name of Primary School:

★ Address of Primary School:

★ From which Date To which Date:

Phone Number of Primary School:

Email Address of Primary School:

Name of Headteacher:

Headteacher's Phone:

Post you held in Primary School:

Current Class in Primary School (if still in Primary School, else leave black):

Current Secondary School (If Any)

(Please, only fill this section if you are currently in a Secondary School. Else, skip this section)

Name of Current Secondary School:

Address of Current Secondary School:

From which Date To which Date in Current Secondary School:

Phone Number of Current Secondary School:

Email Address of Current Secondary School:

Name of Head of School/Principal:

Head of School/Principal's Phone:

Current Class in Secondary School:

Reason for leaving Current Secondary School:

Please list subjects and most recent grades or scores obtained.
Don't forget to attach an official academic report

Official Academic Report:

S/N	Subject	Grade	Date
1
2
3
4
5
6
7
8
9
10
11
12

Source of Referral to Mind Builders School

i. Parent ii. Staff iii. Advertisement iv. Others

If either (i) or (ii) above, please provide the referral details below:

Referral's Full Name:

Referral's Contact Phone:

Relationship to Referral:

Admission Form Fees

★ Reference:

★ Date of Payment: