# 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: