CHRISTQ JUNIOR SCHOOL

(Sett11ng Standards 1n Modern E d u c a t i o H

Lot 1476 Vedoko (von en face Colege LABEL Vedoko)
Colonou, Republique du Benin
CE BU LTONIN Email: christoschools@gmail.com
Tel: 96 78 30 57 63 60 72 46
APPLICATION FORM
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sTUPEnT:1 PETAIL
Surname:

First Name: Middle Name

Date of Birth: Place of Bith: Sex: M F
Last School Attended:
Last Class Passed. Class Anticipated:-
Residential Addres:
mE P RIEE
Blood Group: Genoty pe:

Common Sickness (Brief Pls):_

In case of Emergency contact: Dr's Name:

Hospital: Tel:
PARENT*S/GUaRDInn°s PETAILS

Name:

Office Address: Tel

Home Address:_ Tel:

Parent's/Guardian's Sign:

FOR OFFICE USE ONLY

Test Score: Admission No

Class Recommended:
Head Teacher's Remark:
Registrar's Sign/ Date