Form 1: Students & Guardian Information & Declaration

Part 1: Student Information

Please complete the following in its entirety:

Full Name:

Emirates ID Number*:

Gender (circle)*:

Male

Female

Date of birth:

School Name:

School Location:

School Grade Currently:

*Fields in black will be automatically filled, if not, the user should fill it
*Fields in green are updatable

Part 2: Guardian Information

First Guardian (Mandatory)

Full Name:

Emirates ID Number*:

Mobile phone:

Other Phone:

Address:

Email:

Make Emergency contact

+ Add Guardian

Make Primary contact

Make Emergency contact

Student Release Information:

Adults who are not listed as an emergency contact or authorized pickup will not be allowed to pick-up a student.

Name

Relationship to Child

Phone Number

+ ddd Student

Please indicate one:

My child will be picked up

My child will walk home

Any changes made to your child’s release must be submitted to the teacher & Abu Dhabi Department of Education and Knowledge (ADEK) in writing.

Declaration: I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately.

Parent/Guardian Name

Parent/Guardian Signature: