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Student Application Form

Please fill out this form completely to apply for admission to Mizizi Academy. All fields are required unless otherwise specified.

Parent/Guardian Information

Full Name:

Email:

Phone Number:

Relationship to Child:

Residential Address:

Child's Information

Child's Full Name:

Date of Birth:

Gender:

Applying for Grade/Year:

Any Medical Conditions or Allergies? (Optional):

Any Special Educational Needs? (Optional):

Emergency Contact Information

Full Name:

Relationship to Child:

Phone Number:

How Did You Hear About Us?

Please select an option:

Additional Information (Optional):

I hereby declare that the information provided in this application is true and accurate to the best of my knowledge.