Registration Form – Secondary

Payment Referrnce

Surname (required)

First Name(required)

Last Name(required)

State of Origin(required)

Local Govt Area (required)

Tribe (required)

Sex (required) —Please choose an option—FemaleMale

Date of Birth (required)

Admission into (required) —Please choose an option—Play ClassNurseryPrimarySecondary

Previous School Attended (required)

Previous School Date (required)

Father's Name (required)

Mother's Name (required)

Residential Address (required)

Phone Number (required)

WhatsApp Number (required)

Office Address (required)

Religion (required)

Email Address (required)

Indicate any Sickness of Health problem (if any)- (Comma sepreated list)

Attach Copy of Medical Report if any

Attach Photocopy of your Last Result