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Registration and Child Information Form

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PARTICULARS OF THE CHILD

Name: _______________ Surname: __________________ Nickname: _______________


Date of Birth: ____________ (DD/MM/YY) Age: Years: _____ Months: ______ Days: _______

Sex: Girl Boy Place of Birth: _____________________

Language(s) spoken at home: Kannada: Hindi: Others (Please specify): _____________

Nationality: ______________ Previous KG/Nursery/Creche Attended: _____________________________

HOME DETAILS

Father Mother

Full Name _______________________________ ____________________________

Home Address ________________________________________________________________

________________________________________________________________

Occupation _______________________________ ____________________________

Company Name _______________________________ ____________________________

Mobile no. _______________________________ ____________________________

Office no. _______________________________ ____________________________

Res no. ___________________ E-mail Id: ____________________________

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Siblings if any: Brothers: _______ Sisters: ___________

Emergency contact no. (Other than parents): _______________________


Child Birth Details

Were there any complications in or during Pregnancy? ______________________________

Normal delivery/C section _________________________________________

How long was the child’s crawling period? _________________________________________

At what age did the child first walk? __________________________

At what age did the child first talk? __________________________

Is your child toilet trained? __________________________

Family Information: Married / Divorced / Separated / Joint Family / Adopted

Does your child Watch TV/ DVD Yes No

Estimated Watching Time (if Yes) ___________ Hrs. per day.

Does your child use IPads/ Computers/ Electronic Games? Yes No

Estimated usage Time (if Yes) ___________ Hrs. per day

What is your understanding Waldorf Early childhood Education?

____________________________________________________________________________
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Why Do you think Waldorf Education is suited to your child?

____________________________________________________________________________
_

Is there any Information about your child that you would like to share with the school?

____________________________________________________________________________
_

____________________________________________________________________________
_
HEALTH DETAILS

Vaccinations: (Please enter the dates below)

a> BCG _________________ (Yes/No)

b> DPT _________________ (Yes/No)

c> OPV: _________________ (Yes/No)

d> Measles _________________ (Yes/No)

e> MMR _________________ (Yes/No)

f> DT _________________ (Yes/No)

g> HBV_________________ (Hepatitis 1, 2, 3) (Yes/No)

h> H1 B _________________ (Meningitis -3 doses) (Yes/No)

i>Chicken pox _________________ (Yes/No)

j> Typhoid _________________ (Yes/No)

k> Hepatitis A _________________ (2 doses) (Yes/No)

Note: Vaccines (a) to (g) are compulsory; (h) to (k) are optional but recommended once a year.

Past ailments, surgeries and illnesses: _______________________________________________________

______________________________________________________________________________________

Allergies to any food / medicines: ________________________________________________________

_____________________________________________________________________________________to any
of the above Please specify treatment to follow

Is your Child on any continuous medication?

I DECLARE THAT THE INFORMATION GIVEN ABOVE IS CORRECT AND COMPLETE.

Signature of Parent: ______________________ Date: ___________________________