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Al Dhafra Private Schools MBZ CITY ABU DHABI STUDENT INFORMATION FORM APPLICATION DATE FULL NAME AS PER PASSPORT DATE OF BIRTH DAY MONTH PLACE OF BIRTH YEAR HOME ADDRESS COUNTRY REGION CITY ZONE SECTOR TRANSPORTATION MODE TICK ONE PASSPORT INFORMATION PASSPORT NO GENDER PLOT ID STREET BUS PARENT COUNTRY OF ISSUE EXPIRY DATE NATIONALITY EDUCATIONAL INFORMATION ESIS NO. ABU DHABI CURRENT SCHOOL CURRENT GRADE PROPOSED LANGUAGES KNOWN SECOND LANGUAGE FIRST LANGUAGE EMIRATES IDENTITY CARD INFORMATION ID NUMBER CARD NUMBER EXPIRY DATE DAY - MONTH - YEAR ABU DHABI WATER AND ELECTRICITY AGENCY ADWEA INFORMATION PREMISES ID PARENTS INFORMATION PLEASE INDICATE IF PARENTS ARE SEPARATED / DIVORCED YES FATHER NO MOTHER NAME HOME PHONE MOBILE NUMBER MAIL ADDRESS PROFESSION COMPANY NAME OFFICE NUMBER PRIMARY CONTACT TICK ONE LEARNING SUPPORT NEED DETAILS HAS YOUR CHILD EVER Y N Been evaluated for learning problems Been suspended from school Been recommended for remedial measures Repeated a level at school for any reason Been identified as having special physical emotional psychological or language needs MEDICATION ALLERGIES PLEASE PROVIDE MORE DETAILS BELOW IF YOU HAVE ANSWERED YES Y TO ANY OF THE ABOVE* PERSON TO NOTIFY IN CASE OF EMERGENCY OTHER THAN THE PARENTS CONTACT NAME MOBILE RELATIONSHIP ACKNOWLEDGEMENT DISCLAIMER I grant permission for my child to attend/participate in school-sponsored field trips and other school related activities. I have shared all relevant information about my child s achievement and behaviour disclosing all information fully including any psycho-educational testing that my child has undergone. I am aware that periodically photographs are taken in school and give my full permission for my child to be included in photographs even if they published in school promotional material or the media* Various standardized tests are administered to students throughout the school year to gain information about the School s Learning Program and individual needs of the students. I understand that my child will participate in tests administered by the school* I agree to support my child in following getting to know and understand the school s procedures and regulations. I HAVE READ THE ABOVE STATEMENT AND GRANT PERMISSION / AGREE TO THE INFORMATION ON THIS FORM. LEGAL PARENT / GUARDIAN SIGNATURE REQUIRED DOCUMENTS 1 PASSPORT COPY A4 size colored copy of the parents Mom and Dad and student s passport and visa 1 BIRTH CERTIFICATE COPY A4 size colored if from abroad attested from Embassy and Ministry of Foreign Affair. 1 IMMUNISATION COPY A4 size colored 4 PASSPORT PHOTOS 1 COPY OF WATER AND ELECTRICITY As ADEC requirement 1 STUDENTS COPY OF EMIRATES ID Both sides as ADEC requirement ORIGINAL TRANSFER CERTIFICATE Stamped from ADEC if from abroad attested from Embassy and Ministry of Foreign Affair. ORIGINAL REPORT CARD Stamped from ADEC if from abroad attested from Embassy and Ministry of Foreign Affair. ABU DHABI CURRENT SCHOOL CURRENT GRADE PROPOSED LANGUAGES KNOWN SECOND LANGUAGE FIRST LANGUAGE EMIRATES IDENTITY CARD INFORMATION ID NUMBER CARD NUMBER EXPIRY DATE DAY - MONTH - YEAR ABU DHABI WATER AND ELECTRICITY AGENCY ADWEA INFORMATION PREMISES ID PARENTS INFORMATION PLEASE INDICATE IF PARENTS ARE SEPARATED / DIVORCED YES FATHER NO MOTHER NAME HOME PHONE MOBILE NUMBER MAIL ADDRESS PROFESSION COMPANY NAME OFFICE NUMBER PRIMARY CONTACT TICK ONE LEARNING SUPPORT NEED DETAILS HAS YOUR CHILD EVER Y N Been evaluated for learning problems Been suspended from school Been recommended for remedial measures Repeated a level at school for any reason Been identified as having special physical emotional psychological or language needs MEDICATION ALLERGIES PLEASE PROVIDE MORE DETAILS BELOW IF YOU HAVE ANSWERED YES Y TO ANY OF THE ABOVE* PERSON TO NOTIFY IN CASE OF EMERGENCY OTHER THAN THE PARENTS CONTACT NAME MOBILE RELATIONSHIP ACKNOWLEDGEMENT DISCLAIMER I grant permission for my child to attend/participate in school-sponsored field trips and other school related activities. I have shared all relevant information about my child s achievement and behaviour disclosing all information fully including any psycho-educational testing that my child has undergone..

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