Student Enrollment Form

Regd No . 639 Regd. Under U.P. Govt.
Raj English Study Point
Near life line hospital Hidayet Nagar Lakhimpur kheri
Admission Form
Enrollment Status
- Full Time
- Part Time
The department needs to ask for personal information from students, parents and guardians so it can plan, provide and report on its services

Please take the time to read this as it outlines in greater detail the use and disclosure of the information that you provide.
What was the last school the student attended?
Proof of identity attached (e.g. birth certificate, Medicare card, health care card)
Gender
For senior secondary students only. Student’s contact details:
- Allergies
- Seizure disorder
- Asthma
- Physical disability
Medication required.
1. Please supply details of any treatments, care or medication required.
2. Relevant medical consent forms completed and attached.
3. Immunisation certificate/record provided.
Parents Consent
- I give consent to the sharing of health information between schools and Department of Health and Families (DHF) as stated in the privacy statement
- I give consent to a school health surveillance check when my child is in Transition
- I give consent to my primary school child having a dental examination
It is your responsibility to notify the school in writing of any changes to the information provided on this enrollment form.

Name of parent/guardian/independent student enrolling the student and providing consents:

Raj English Study Point