Apply Now – Distar School

DISTAR SCHOOL

Playgroup, Pre-Primary & Primary

P.O BOX 99129 MOMBASA.
TEL. 0707 761 484
Email: distarschool@gmail.com

Admission Form

Learner's Details

First, Middle & Last Name

Class

Date of Birth

Age

Gender

Medical Condition (if any)

Medicines or food the child is allergic to (if any):

Any special needs

If any kindly explain

Child’s Physician/Doctor

Physician's phone

Area of Residence

Home County

Sub County

Parent/Guardian Details

Mother's First, Middle & Last Name

I.D. No

Mobile No

Occupation

Company name

Father's First, Middle & Last Name

I.D. No

Mobile No

Occupation

Company name

Guardian's Name

I.D. No

Mobile No

Occupation

Company name

Siblings

Emergency Information

In case of an emergency, list at least two names of persons to be contacted in the eventuality we cannot reach either of the parents/guardian (Not Parents)

Name

Mobile No

Relationship to child

Name

Mobile No

Relationship to child

Person authorised to pick the child

Name

Mobile No

Please attach a copy of;

1. Learner's birth certificate

2. Parent(s) ID card

I accept theTerms and Conditions

DISTAR SCHOOL

Playgroup, Pre-Primary & Primary

Admission Form

Learner's Details

Parent/Guardian Details

Emergency Information

Person authorised to pick the child

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Today

Apply

Now

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Visit