Candidate's Name * [text* full-name]

Candidate's Picture * [file* file-709 filetypes:jpg|png|jpeg]

Candidate's DOB * [date* date-372 min:2002-01-01 max:2009-01-01]

Candidate's Age * [number* number-397 min:10 max:18]

Candidate's Gender * [radio radio-112 use_label_element default:1 "Boy" "Girl"]

Present School * [text* text-736 placeholder "Name of Secondary School"]

School Address * [text* text-737]

Class Level * [select* menu-252 include_blank "JSS 1" "JSS 2" "JSS 3" "SSS 1" "SSS 2" "SSS 3"]

Home Address * [text* text-738]

Parent/Guardian's Name * [text* text-739]

Profession [text text-740]

Phone 1* [number* number-398 min:0100000000 placeholder "Mobile/Work/Home"]

Phone 2* [number* number-399 min:000000000000000 placeholder "Mobile/Work/Home"]

Email * [email* email-501]

Allergies or other medical concerns * [radio radio-807 default:2 "Yes" "No"]

[group group-774] Specify details of allergies or other medical concerns [textarea textarea-448] [/group]

Will your child be bringing a PC * [radio radio-808 use_label_element default:1 "Yes" "No"]

Select Laboratory Type * (If your child is not bringing his own laptop, then you can select Coventional) [radio radio-809 default:1 "Bring Your Own Device" "Conventional"]

Interested in Shuttle service * [radio radio-810 default:2 "Yes" "No"]

[submit "Submit"]