Admiralty University of Nigeria

Child's personal data

Please fill in appropriate details.

Passport Photograph

First Name

Last Name

Other Name

Date of Birth

Nationality

State of Origin

Local Government

Residential Address

Last School Attended

Previous Class

Religion

Denomination (if Catholic)

Gender

Class

Medical Details

Blood Group

Genotype

Speech Development

Sight

Medical History

Allergics

Parent's Section

Father's Details

Full Name

Phone Number

Occupation

Office Address

Mother's Details

Full Name

Phone Number

Occupation

Office Address

Guardian Section

If child is living with a relative complete the information below.

Full Name

Phone Number

Occupation

Office Address

Home Address

Relationship

Declaration

I hereby confirm that the information provided above is correct.

Child's personal data

Medical Details

Parent's Section

Father's Details

Mother's Details

Guardian Section

Declaration

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