Student Information UPDATE Form – St. Luke’s Academy

Fields marked with an * are required.

Student Name

First

Last

Date of Birth

Religion

Student's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Student's Current Class Sept 2022

Student's Security Password

Mother's/Guardian's Full Name

First

Last

Nationality

Title

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Personal Email

Work Email

Home Phone

Mobile Phone

Work Phone

If a work phone is not available, please input an alternate number that you can be contacted directly.

Occupation

Place of Work

Father's/Guardian's Full Name

First

Last

Nationality

Title

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Personal Email

Work Email

Home Phone

Mobile Phone

Work Phone

If you don't have a work phone, please input a number that you can be contacted direcly.

Occupation

Place of Work

Emergency Contact/Guardian's Name

First

Last

Emergency Contact/Guardian's Phone

Siblings Names and Ages

Name of Pediatricians

First

Last

Pediatrician Phone

Immunisation Up to Date

Yes
No

Any Knows Allergies

Any noted learning difficulties/delays

In case of emergency, permission is 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 outing on the school's website/Facebook page or in advertising/flyers etc. even after the child is no longer enrolled with us or graduates?

Yes
No

I have received and read the updated School Policy Handbook and agree to abide by all school policies.

Parent's/Guardian's Full Name

First

Last

Date

St. Luke's Academy

Inspiring Excellence

I have received and read the updated School Policy Handbook and agree to abide by all school policies.

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