Online Enrolment Form – St. Luke’s Academy

Fields marked with an * are required

Student enrolling in:

Montessori Class: 3+ years on or before August 31st of the Academic Year this application is for
Primary Department : 6+ years on or before August 31st of the Academic Year this application is for

Student's Name

First

Last

What Child Prefers to be called

Date of Birth

Child’s Age as of August 31st prior to Start Date

Years

Months

National ID/Passport #

Gender

Male
Female

Country of Birth

Religion

Student is a:

National Student
Caricom Student
International Student

Student's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Current School Attending

Current class enrolled in

List of all educational facilities enrolled at including the year(s) of attendance:

Name Of Facility

Years Enrolled

Name Of Facility

Years Enrolled

Name Of Facility

Years Enrolled

Has the child ever submitted an application to St. Luke’s Academy

No , first time applicant
*Yes - if yes please list year

*Yes - if yes please list year

Is the Child a Returning Student, Previously Enrolled at St Luke’s Academy

Yes , if yes please list year
No, first time applicant

If "yes", year application was submitted

Please select Mother's/Guardian's Preferred Title

Mrs.
Miss.
Ms.
Dr.

Mother's/Guardian's Full Name

First

Last

Nationality

Mother's/Guardian’s Address: If different from students address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mother's/Guardian’s Personal Email

Email

Confirm Email

Mother's/Guardian’s Work Email

Email

Confirm Email

Mother's/Guardian's Home Phone

Mother's/Guardian's Mobile Phone

Mother's/Guardian’s Occupation

Mother's/Guardian's Work Phone

Mother's/Guardian’s Place of Work

Marital Status (Mother/Guardian)

Please select Father's/Guardian’s Preferred Title

Mr.
Dr.

Father's/Guardian’s Full Name

First

Last

Nationality

Father's/Guardian’s Address: If different from students address.

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Father's/Guardian’s Personal Email

Father's/Guardian’s Work Email

Email

Confirm Email

Father's/Guardian’s Home Phone

Father's/Guardian’s Cell Phone

Father's/Guardian’s Work Phone

Father's/Guardian’s Occupation

Father's Place of Work

Marital Status (Father/Guardian)

Emergency Contact/Guardian's Name

First

Last

Emergency Contact/Guardian's Phone

Primary Contact for School Notices and Updates via Email

Mother/Legal Guardian
Father/Legal Guardian
Emergency Contact
Other

If you selected "Other" please indicate Name, Email and phone number

Primary Contact for urgent or Time - Sensitive WhatsApp Notices

Mother/Legal Guardian
Father/Legal Guardian
Emergency Contact
Other

If you selected "Other" please indicate Name, Email and phone number

Primary Contact for All Emails Related to Accounts & Payments

Mother/Legal Guardian
Father/Legal Guardian
Emergency Contact
Other

If you selected "Other" please indicate Name, Email and phone number

Does the child have any family currently or previously enrolled at St. Luke’s Academy

Yes
No

If yes , which House were they in

Blue
Red

Siblings’ Names, Ages and Schools Currently Attending

Name of Pediatrician

First

Last

Pediatrician’s Work Phone

Immunisations Up to Date

Yes
No

Any Known Allergies - please specify

Any Noted or Assessed Learning Difficulties and or Developmental Delays

In Case of Emergency, is permission granted to take child to hospital

Yes
No

Is permission granted to use pictures or videos of your child taken either at school or on outings on the school's website/facebook or in advertising/flyers etc. even after the child is no longer enrolled with us or graduates

Yes
No

We hereby state that all the information provided on this form is true and accurate

Layout

Dated this:

Date Applying for Enrollment to Commence

Projected Student Leaving Date

Name of person completing the online application:

First

Last

Have you ever done a school tour at St. Luke's Academy before?

Yes
No

Would you be interested in having a school tour?

Yes
No

Relationship to student being applied for

What is 7 x 24?

St. Luke's Academy

Inspiring Excellence

Child’s Age as of August 31st prior to Start Date

List of all educational facilities enrolled at including the year(s) of attendance:

We hereby state that all the information provided on this form is true and accurate

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