Enrol

Kipina welcomes children from 4 months to up to 4 years.

Please fill out your details below and one of our staff will respond to you shortly.





Child’s Details

Start Date (SEPT 2017 Term):

First name:


Last name:


Date of Birth (YYYY-MM-DD):


Gender:

MaleFemale

Nationality:


First Language:


Mother’s Details

Name:


Email:


Nationality:


Mobile phone:


Home phone:


Area of residence in UAE:


UAE ID Number:


Passport information:


Father’s Details

Name:


Email:


Nationality:

Mobile phone:


Home phone:


Area of residence in UAE:


UAE ID Number:


Passport information:


Kipina Sessions

Time & Day


Emergency Contact Details















Medical Details

Password to be used when calling by phone

Child’s doctor:


Name of clinic:


Clinic Phone:


Clinic Address:


Does your child have any known health problems?

YesNo

If yes, please specify:


Has your child had any of the following illnesses?

(* Hold down the Ctrl / Cmd key to select more than one item)


If you have ticked any of the boxes above please provide the details here or see the Principal:


Please list any serious accidents, operations or injuries the child has had:


If your child has any known allergies please tell us what it is and your child’s reactions to it:


If your child takes any medication an a regular basis, please tell us the name of the medication and your child’s condition:


Do you want the nursery to dispense the medication(s)?

Yes pleaseNo thanks

If yes, please specify if the nursery has to dispense the medications and the schedule for dispensing:


Please comment on any other medical information or special needs Kipina needs to be made aware of:


Documentation:

The following documents must be submitted with the online application or provided in person to Kipina’s Admission’s Officer.

Copy of Child’s Birth Certificate


Copy of Child’s Passport


A colour photo of your child (head and shoulders)


Copy of vaccination and immunization record


Authorization

Your Name

Your relationship to child

By checking the ‘I agree’ box below you authorize the staff/management of Kipina to obtain the following services for your child if necessary: Nurse/Physician and/or Ambulance in the event of an emergency. Please note that Ambulance fees and/or health care costs are the responsibility of the parent/guardian.

I agreeI disagree