Registration Form

Please Provide Correct Information !!

Personal Details

Surname:

Other Names:

Date of Birth:

Gender: -- Select -- Male Female

Contact Information

Home Town:

Local Government Area:

Country of Origin:

State of Origin:

Residential Address:

Admission Information

Application No:

Class: -- Select -- JSS 1 JSS 2 JSS 3 SS 1 SS 2 SS 3

Parent / Guardian Information

Name of Parent/Guardian:

Parent/Guardian's Phone Number:

Health Information

Blood Group: -- Select -- A+ A- AB+ AB- B+ B- O+ O-

Genotype: -- Select -- AA AC AS SS

Medical Allergies:

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