Euned Inlet-1
Euned Inlet-1
SCHOOL STAMP
NB: PARENT/GUARDIAN TO INDEMNIFY HIS OR HER CHILD
BELOW BY SIGNING THE INDEMNITY FORM BELOW;
I understand that he/she will take part entirely at his his/her own risk, and that
while every precaution and care will be taken by the organisers neither they nor
the Head, nor any member of the staff will be held responsible for any accident,
illness or any injury which may occur during or as a result of the visit.
Furthermore, I authorize the organisers, the Head and members of staff to act “in
loco parentis” and empower them to authorize any surgical operations or other
essential medical treatments which for any reason become necessary during the
school visits and acknowledge that, the Ministry of Primary and Secondary
Education or Government is indemnified from any legal suit which may result
from disputes or accidents involving my child.
Date………………………………………………………….. Signature …………………………………
Address ……………………………………………………………………………………………………….
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Tel: ……………………………………………………………………………………………………………..
KEY TO GRADES (PRIMARY)
45-50 90-100 1
40-44 80-89 2
35-39 70-79 3
30-34 60-69 4
25-29 50-59 5
20-24 40-49 6
15-19 30-39 7
10-14 20-29 8
0-9 0-19 9
SOCIAL BACKGROUND INFORMATION
Name of child …………………………………………………………………………………………………………………………..
Date Enrolled at ECD Centre ……………………………………………………………………………………………………..
Date of birth ……………………………………………………… Birth Cert No ……………………………………………….
Sex ……………………… Race …………………………………………. Denomination…………………………………..
Name of Father ………………………………………………………… Occupation ………………………………………
Name of Father ………………………………………………………… Occupation ………………………………………
Home Address ………………………………………………………………………………………………………………………….
Telephone: Home ……………………………… Business …………………………… Personal ………………………
Number of Children in the Family i.e. Males………………………………… Females ……………………….
Position of Child in the Family …………………………………………………………………………………………………..
Is he/she physically or mentally challenged? Does he/she have other special needs? Yes/No
If Yes, Elaborate ……………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………..
Child’s interests ………………………………………………………………………………………………………………………..
Staple Diet ……………………………………………………………………………………………………………………………….
Allergies …………………………………………………………………………………………………………………………………..
TERM 1 TERM 2 TERM 3
WEIGHT (kg)
HEIGHT (cm)
MUAC (cm)
COMMENTS …………………………………………………………………………………………………………………………….....
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GROSS MOTOR CO-ORDINATION TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can balance
Can hop on alternate legs
Can catch with both hands
Can throw
Can jump
Can name parts of his/her job
Is confident in the water
COMMENTS ………………………………………………………………………………………………………………………………………….……………….....
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POSITION …………………………………….……………………………………..OUT OF ………………………………………………………………………..…
CLASS TEACHER’S COMMENTS ………………………………………………………………………………………………………………………………..….
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CHARACTER AND CONDUCT...……………………………………………………………………………………………………………………..…………..….
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HEAD’S COMMENT …………………………………………………………………………………………………………………. …
………………………………………………………………………………..…………………………………………………………………
NEXT TERM BEGINS ON ………………………………………………….………………………………………….. SCHOOL STAMP
NEXT TERM FEES ……………………………………………………………………………………………………...…
PARENT GUARDIAN’S SIGNATURE…………………………………………………………………………………………..
CLASS: …………….…………………………………………………………….…… YEAR: ……………..……………………….......
TERM: ………………………………………. TERM ATTENDANCE …………..……….. OUT OF…………..………………
EMOTIONAL AND SOCIAL DEVELOPMENT TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can play with others
Can share
Can control his/her feelings
Take pride in his/her achievements
Can relate to a group
Can take good care of his/her apparatus
Can take care of his/her possessions
Can concentrate and attend for ten minutes
Can complete tasks
Knows his/her name and age
Knows his/her guardian telephone number
Knows his/her address
COMMENTS …………………………………………………………………………………………………………………………….....
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GROSS MOTOR CO-ORDINATION TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can balance
Can hop on alternate legs
Can catch with both hands
Can throw
Can jump
Can name parts of his/her job
Is confident in the water
COMMENTS ………………………………………………………………………………………………………………………………………….……………….....
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POSITION …………………………………….……………………………………..OUT OF ………………………………………………………………………..…
CLASS TEACHER’S COMMENTS ………………………………………………………………………………………………………………………………..….
……………………………………………………………………………………………………………………………………………………………………………..………
……………………………………………………………………………………………………………………………………………………………………………..………
CHARACTER AND CONDUCT...……………………………………………………………………………………………………………………..…………..….
……………………………………………………………………………………………………………………………………………………………………………………..
HEAD’S COMMENT …………………………………………………………………………………………………………………. …
………………………………………………………………………………..…………………………………………………………………
NEXT TERM BEGINS ON ………………………………………………….………………………………………….. SCHOOL STAMP
NEXT TERM FEES ……………………………………………………………………………………………………...…
PARENT GUARDIAN’S SIGNATURE…………………………………………………………………………………………..
CLASS: …………….…………………………………………………………….…… YEAR: ……………..……………………….......
TERM: ………………………………………. TERM ATTENDANCE …………..……….. OUT OF…………..………………
EMOTIONAL AND SOCIAL DEVELOPMENT TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can play with others
Can share
Can control his/her feelings
Take pride in his/her achievements
Can relate to a group
Can take good care of his/her apparatus
Can take care of his/her possessions
Can concentrate and attend for ten minutes
Can complete tasks
Knows his/her name and age
Knows his/her guardian telephone number
Knows his/her address
COMMENTS …………………………………………………………………………………………………………………………….....
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……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
GROSS MOTOR CO-ORDINATION TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can balance
Can hop on alternate legs
Can catch with both hands
Can throw
Can jump
Can name parts of his/her job
Is confident in the water
COMMENTS ………………………………………………………………………………………………………………………………………….……………….....
…………………………………………………………………………………………………………………………………………………………………….……………
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POSITION …………………………………….……………………………………..OUT OF ………………………………………………………………………..…
CLASS TEACHER’S COMMENTS ………………………………………………………………………………………………………………………………..….
……………………………………………………………………………………………………………………………………………………………………………..………
……………………………………………………………………………………………………………………………………………………………………………..………
CHARACTER AND CONDUCT...……………………………………………………………………………………………………………………..…………..….
……………………………………………………………………………………………………………………………………………………………………………………..
HEAD’S COMMENT …………………………………………………………………………………………………………………. …
………………………………………………………………………………..…………………………………………………………………
NEXT TERM BEGINS ON ………………………………………………….………………………………………….. SCHOOL STAMP
NEXT TERM FEES ……………………………………………………………………………………………………...…
PARENT GUARDIAN’S SIGNATURE…………………………………………………………………………………………..
CLASS: …………….…………………………………………………………….…… YEAR: ……………..……………………….......
TERM: ………………………………………. TERM ATTENDANCE …………..……….. OUT OF…………..………………
EMOTIONAL AND SOCIAL DEVELOPMENT TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can play with others
Can share
Can control his/her feelings
Take pride in his/her achievements
Can relate to a group
Can take good care of his/her apparatus
Can take care of his/her possessions
Can concentrate and attend for ten minutes
Can complete tasks
Knows his/her name and age
Knows his/her guardian telephone number
Knows his/her address
COMMENTS …………………………………………………………………………………………………………………………….....
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……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
GROSS MOTOR CO-ORDINATION TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can balance
Can hop on alternate legs
Can catch with both hands
Can throw
Can jump
Can name parts of his/her job
Is confident in the water
COMMENTS ………………………………………………………………………………………………………………………………………….……………….....
…………………………………………………………………………………………………………………………………………………………………….……………
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………………………………………………………………………………………………………………………………………………………….………………………
POSITION …………………………………….……………………………………..OUT OF ………………………………………………………………………..…
CLASS TEACHER’S COMMENTS ………………………………………………………………………………………………………………………………..….
……………………………………………………………………………………………………………………………………………………………………………..………
……………………………………………………………………………………………………………………………………………………………………………..………
CHARACTER AND CONDUCT...……………………………………………………………………………………………………………………..…………..….
……………………………………………………………………………………………………………………………………………………………………………………..
HEAD’S COMMENT …………………………………………………………………………………………………………………. …
………………………………………………………………………………..…………………………………………………………………
NEXT TERM BEGINS ON ………………………………………………….………………………………………….. SCHOOL STAMP
NEXT TERM FEES ……………………………………………………………………………………………………...…
PARENT GUARDIAN’S SIGNATURE…………………………………………………………………………………………..
CLASS: …………….…………………………………………………………….…… YEAR: ……………..……………………….......
TERM: ………………………………………. TERM ATTENDANCE …………..……….. OUT OF…………..………………
EMOTIONAL AND SOCIAL DEVELOPMENT TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can play with others
Can share
Can control his/her feelings
Take pride in his/her achievements
Can relate to a group
Can take good care of his/her apparatus
Can take care of his/her possessions
Can concentrate and attend for ten minutes
Can complete tasks
Knows his/her name and age
Knows his/her guardian telephone number
Knows his/her address
COMMENTS …………………………………………………………………………………………………………………………….....
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
GROSS MOTOR CO-ORDINATION TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can balance
Can hop on alternate legs
Can catch with both hands
Can throw
Can jump
Can name parts of his/her job
Is confident in the water
COMMENTS ………………………………………………………………………………………………………………………………………….……………….....
…………………………………………………………………………………………………………………………………………………………………….……………
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………………………………………………………………………………………………………………………………………………………….………………………
POSITION …………………………………….……………………………………..OUT OF ………………………………………………………………………..…
CLASS TEACHER’S COMMENTS ………………………………………………………………………………………………………………………………..….
……………………………………………………………………………………………………………………………………………………………………………..………
……………………………………………………………………………………………………………………………………………………………………………..………
CHARACTER AND CONDUCT...……………………………………………………………………………………………………………………..…………..….
……………………………………………………………………………………………………………………………………………………………………………………..
HEAD’S COMMENT …………………………………………………………………………………………………………………. …
………………………………………………………………………………..…………………………………………………………………
NEXT TERM BEGINS ON ………………………………………………….………………………………………….. SCHOOL STAMP
NEXT TERM FEES ……………………………………………………………………………………………………...…
PARENT GUARDIAN’S SIGNATURE…………………………………………………………………………………………..
CLASS: …………….…………………………………………………………….…… YEAR: ……………..……………………….......
TERM: ………………………………………. TERM ATTENDANCE …………..……….. OUT OF…………..………………
EMOTIONAL AND SOCIAL DEVELOPMENT TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can play with others
Can share
Can control his/her feelings
Take pride in his/her achievements
Can relate to a group
Can take good care of his/her apparatus
Can take care of his/her possessions
Can concentrate and attend for ten minutes
Can complete tasks
Knows his/her name and age
Knows his/her guardian telephone number
Knows his/her address
COMMENTS …………………………………………………………………………………………………………………………….....
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
GROSS MOTOR CO-ORDINATION TERM 1 TERM 2 TERM3
YES NO YES NO YES NO
Can balance
Can hop on alternate legs
Can catch with both hands
Can throw
Can jump
Can name parts of his/her job
Is confident in the water
COMMENTS ………………………………………………………………………………………………………………………………………….……………….....
…………………………………………………………………………………………………………………………………………………………………….……………
………………………………………………………………………………………………………………………………………………………….………………………
………………………………………………………………………………………………………………………………………………………….………………………
POSITION …………………………………….……………………………………..OUT OF ………………………………………………………………………..…
CLASS TEACHER’S COMMENTS ………………………………………………………………………………………………………………………………..….
……………………………………………………………………………………………………………………………………………………………………………..………
……………………………………………………………………………………………………………………………………………………………………………..………
CHARACTER AND CONDUCT...……………………………………………………………………………………………………………………..…………..….
……………………………………………………………………………………………………………………………………………………………………………………..
HEAD’S COMMENT …………………………………………………………………………………………………………………. …
………………………………………………………………………………..…………………………………………………………………
NEXT TERM BEGINS ON ………………………………………………….………………………………………….. SCHOOL STAMP
NEXT TERM FEES ……………………………………………………………………………………………………...…
PARENT GUARDIAN’S SIGNATURE…………………………………………………………………………………………..
TERM: …………….………………………GRADE ………………………….…… YEAR: ……………..………………………
ATTENDANCE …………..……………………….…….. OUT OF…………………………………………..………….DAYS
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AGRICULTURE
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