APPLICATION FORM PRE-PRIMARY/PRIMARY SECTION

Name in full :.....................................................................................................................................................................................

(Block letters – First / Middle / Last) (Underline the name used at home)
Date of Birth: ...................................................................................... Age :.................................................................................
Month Day Year
Birth place :............................................................................... Gender : ...................................................................................
Ethnicity : .................................................................... Passport Number:...............................................................................
National ID of the parents/guardian(Copy to be provided)
Expected Start Date :..................................................................... Grade to be entered:...............................................
Local address: .................................................................................................................................................................................
Identifying Landmarks :..............................................................................................................................................................
.................................................................................................................................................................................................................
Student lives with: Mother Father Both Guardian
Address................................................................................................................................................................................................
..........................................................................................................Phone no:..................................................................................

FATHER’S INFORMATION MOTHER’S INFORMATION:

Father’s name : Mother’s name :
Occupation: Occupation:
Designation: Designation:
Employer: Employer:
Nationality : Nationality :
Volunteer interests: Volunteer interests:
Postal address: Postal address:
Home address : Home address :
Contact no. (Office) : Contact no. (Office) :
Contact no. (Home) : Contact no. (Home) :
Mobile Phone: Mobile Phone:
E- mail: E- mail:

The Hungry Caterpillar School +256 200 900 134 [email protected]

Plot 1 A, Lugogo Bypass, +256 200 900 135 www.thehungrycaterpillarug.com
PO Box 28970, Kampala, Uganda
Emergency Contact :
Name: ..................................................................................................................................................................................................
Relationship:......................................................................................................................................................................................
Contact no. (Residence).....................................................Contact no. (Office) . .........................................................
Mobile no. ..........................................................................................................................................................................................

Overseas Contact (If applicable):

Name :..................................................................................................................................................................................................
Address:...............................................................................................................................................................................................
Country :........................................................................................ Phone:......................................................................................
E-mail :................................................................................................................................................................................................

SIBLINGS:
NAME GENDER DATE OF BIRTH SCHOOL (IF APPLICABLE)

PREVIOUS SCHOOL EXPERIENCE: (IF APPLICABLE) KINDLY ATTACH THE REPORT CARD

1. Name of the school ..................................................................................................................................................................

Address :.............................................................................................................................................................................................
Grades attended :..................................................From : .................................................To :................................................

YES NO
Is your child allergic to anything :
Is your child asthmatic or epileptic?
Has your child had academic difficulties?
Has your child been referred for psychological counseling?
or testing?

References (within Uganda where possible)

1. Name: ......................................................................................2. Name: .................................................................................
Address: ......................................................................................Address: .................................................................................

The Hungry Caterpillar School +256 200 900 134 [email protected]

Plot 1 A, Lugogo Bypass, +256 200 900 135 www.thehungrycaterpillarug.com
PO Box 28970, Kampala, Uganda
How many years has the student studied in a school with english as the first language?.....................
Describe english language proficiency: fluent fair poor

Photographs and videos of school events are posted on the school website regularly. The
school would like to seek your permission to include your child’s photos on our school official
website and social media sites. Yes No

I declare that the above information is correct. I permit my child’s full participation in all the
activities including religious instruction, which the school includes in its curriculum.

Signature of Parent : ........................................................................................ Date:.........................................................

CHECK LIST REQUIRED DOCUMENTS

Fee structure Copy of Birth Certificate

Calendar Copy of immunization card

Health Record form Transcript previous school (If Applicable)

Brochure Four Photographs of the child

Photos of parents/ guardians

responsible to pick up the child from school
Admission policy

How did you come to know about The Hungry Caterpillar?

Through ads
Radio Newspapers Billboards
Through social media
Facebook Twitter Instagram
Through friends and relatives Through parents of current or old students
Through google search Through word of mouth from others
Other (please specify)................................................................................................................................................................

The Hungry Caterpillar School +256 200 900 134 [email protected]

Plot 1 A, Lugogo Bypass, +256 200 900 135 www.thehungrycaterpillarug.com
PO Box 28970, Kampala, Uganda