Admission Form

C-Rose Academy

#15, New Jerusalem, Road 6, Off Pipe Line, Rumukwurusi, Port Harcourt.

+2348169950123

info@c-roseacademy.com

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Basic Information:

Student Name:

Student Type:

Birth Date:

Gender:

Religion:

Caste:

Blood Group:

Contact Information:

Phone:

National ID:

Present Address:

Permanent Address:

Academic Information:

Class:

Section:

Group:

Second Language:

Previous School Information:

Previous School:

Previous Class:

Father Information:

Father Name:

Father Phone:

Father Education:

Father Profession:

Father Designation:

Mother Information:

Mother Name:

Mother Phone:

Mother Education:

Mother Profession:

Mother Designation:

Other Information:

Email:

Health Condition :

Other Info:

Guardian Information:

Guardian Name:

Relation With Guardian :

Phone:

Email :

Religion:

Profession :

National ID:

Present Address:

Permanent Address:

Other Info:

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