Apply to Join DCIS Academy Apply to Join DCIS Academy REGISTRATION FORM - ECA Academy Pupil’s InformationParent/Guardian InformationFamily SituationEmergency ContactsAuthorized Persons for Pick-UpAuthorization for Display of Child’s ImageMedical Information ECA ACADEMY REGISTRATION FORM2024/2025 ACADEMIC YEARStudent InformationFull NameDate of BirthPlace of BirthNationalitySpoken LanguageGender- Select -MaleFemaleSchool Currently AttendingClassPreviousNextParent/Guardian InformationRelationship to Student- Select -FatherMotherOtherYour Relationship to the StudentFull NameDate of BirthNationalityContact NumberEmailAddressAddressCityRegionCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweOccupationPosition (Employer)PreviousNextEmergency ContactsNamePhone NumberRelationshipAddressPreviousNextAuthorized Persons for Pick-Up (Provide photocopy of ID)Authorized Person 1NameContact NumberRelationship to PupilAddressAdd another Authorized Person for Pick-Up? Yes YesAuthorized Person 2NameContact NumberRelationship to PupilAddressPreviousNextClub SelectionSelect Clubs (Choose one or more)- Select -Art & ExpressionCoding (ICT)ArabicKarateFootballBallerinaMind GamesScienceSewingMusicSD MathsSwimmingTennisPom Pom GirlsPreviousNextAuthorization for Display of Child’s Image (Check options as appropriate)Class Picture Yes NoSchool Website Yes NoNewspaper/Book Publication Yes NoExhibitions Yes NoOther Means of Communication Yes NoTalent Show Participation Yes NoPreviousNextMedical InformationStudent’s Hospital and Doctor in ChargeHospital NameHospital Contact and AddressDoctor’s NameDoctor’s Contact and AddressAuthorization in Case of EmergencyAuthorization of Clinic/Doctor Treatment Yes NoMinor Illness/Emergency Treatment by DCIS Medical Staff Yes NoHealth ReportDoes your child suffer from any health condition? Yes NoExplanationIs your child on any particular medication? Yes NoMedicationDosageReasonOther Illnesses/ConditionsPreviousNextDeclarationDeclaration Statement: "I declare that all the information given is correct."DateParent/Guardian Signature Previous Submit Form
