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EKISAAKAATE
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EKISAAKAATE KYA NNABAGEREKA
Gatonnya 2026
REGISTRATION FORM
Participant's Information
Participant's Name
Age
School
Class
Gender
Clan
Health
Does your child have a personal doctor?
YES
NO
Doctor's Name
Doctor's Contact
Will your child need to take any prescribed medication while at Ekisaakaate Kya Nnabagereka?
Yes
No
Does your child have any allergy?
YES
NO
ALLERGY
Food (Emmere)
Medicine (Edaggala)
Insects (Ebiwuka)
Other (Ekilala)
Special activities to be restricted for health reasons:
PARENT / GAURDIANS INFORMATION
Mother's Name
Contact
Profession / Place of work
Father's Name
Contact
Profession / Place of work
Emergency contact person
Name of contact person
Relationship
Contact
Name and contacts of person(s) other than parents allowed to pick up your child
Name
Contact
Any special instructions, such as custody or restraining orders must be attached to this application and discussed personally with the EKN-Manager. All information wil be kept confidential.
How did you get to know about the EKN program?
Any special issue/s you want to be addressed during the EKN program. Inrelation to your child?
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