Application Form – Primary Years 2 –6 D ate: _______________ Applying for: DD / MM / YY Application No: ______ A cademic year 20____20___ APPLICANT: Last Name First Name Middle Name Date of b irth : ____/______/__ Age: ____ _____ ID No. _________________________________ Passport No. _________________ f Birth: __________________________ Nationality: ___________________ Last Sch ool Year: _______________________ Home Address: Home Te lephone: ______________________________ First Language: _________________________ Other languages spoken: _________________ English l evel: Basic e of brother /sister Age School Year Current School
__________ _______________________________
___________ _______________________________
SCHOOLS ATTENDED:
f Institution - City School Year Academic Year Language of Instruction f Institution - City School Years Academic Year Language of Instruction _______________ __________ ____________ ____________________ Name of Institution - City School Years Academic Year Language of Instruction f Institution - City School Years Academic Year Language of Instruction AL INTERESTS Hobbies: ___________________________________________________________________________________ Musical Instruments: _________________________________________________________________________
_____________________________________________________________________________________
PARENTS STATUS Married Divorced Other Specify_______________________ STUDENT LIVES WITH: Mother & Father Grandparents Other Specify: ______________________________ CONTACT ADDRESS IN COUNTRY OF CURRENT RESIDENCE:
Home address: ______________________________________________________________________ ne: _______________Mobile__________________Email______________________________ R INFORMATION ecommended to you The British School, Quito? A British School Family Names: _____________________________________________ d’s Playgroup Name of the Institution: ________________________________ Newspaper Publication Which publication?__________________________________ e Publication Other, please specify___________________________________ INFORMATION The legal guardians of the applicant are: Stepfather Stepmother Others Others (Please specify) (Please specify) SUPPLEMENTARY SERVICES TRANSPORTATION: YES NO MEALS: YES NO Round tri way trip: Location: _________________________________ NCIAL INFORMATION: y payments, Matriculation or additional fees are paid by: If this is the case, please complete the following: Name of the Company: _________________________________________________________________ R.U.C.: ______________________________________________________________________________ Address: ____________________________________________________________________________ Telephone: ___________________________________________________________________________ Contact: _____________________________________________________________________________ STUDENT´S INFORMATION
e complete this form as fully as possible.
our child ever experienced difficulties setting in at a new school? (If yes, please give details)
2. Has y our child ever had any behavioral difficulties? (If yes, please give details)
he child been asked to withdraw from any school? (If yes, please give details)
he child been responsible for any disciplinary incident in any school, being this related to
academic violation or attitude that resulted into a trail period, suspension, voluntary expulsion or
definite expulsion from the institution. (If yes, please give details)
he child failed a school year? (If yes, please give details)
6. Has the applicant been promoted in a school year without attending? (If yes, please give details) 7. Has the applicant received any of the following services in any school?
Advanced classes for gifted children (If yes, please give details)
Academic support / special needs (If yes, please give details)
Emotional/social support (If yes, please give details)
8. Do yo u have any concerns about your child´s social development? (i.e. does he/she have difficulty
making friends? Does he/she only have friends who are older or younger?) (If yes, please give details)
TANT ADMISSIONS NOTICE
The British School, Quito uses a selective admissions policy for all national and international students. Students
with learning difficulties, requiring learning support or intensive English Language support, will be admitted if there are s
paces in the Learning Support or English as an Additional Language (EAL) Departments and the student
In this c ontext, we kindly request that you provide the BSQ with all pertinent documentation about any particular
special l earning need that your child may have. Failure to do so may result in the student concerned being
withdrawn during the admissions process or after the student has commenced classes.
Legal Representative Signature LEGAL GUARDIANS INFORMATION FATHER’S INFORMATION MOTHER’S INFORMATION Full Name: Full Name: Nationality: Nationality: ID No. / Passport: ID No. / Passport: Educational Qualifications: Educational Qualifications: Occupation: Occupation: Name of Emplo Name of Employer: Marital Status: Marital Status: Home Address: Home Address: Home Telephon e / Mobile: Home Telephone / Mobile: E-mail address: E-mail address: Office Telephon e: Office Telephone: Office e-mail address: Office e-mail address: How long do you envisage staying in Quito? Is there any spe cial information that the school should know? IMPORTANT NOTE
hroughout the school year in ten equal monthly payments. They should be paid within the first 10
onth. Absence or illness does not reduce payment as the fee is based on year-round costs. If the
an wishes to withdraw their child from the school they should communicate this in writing to the
a month´s notice. Otherwise, the monthly fee is still applicable. Parents who have an employer
paying school fees on their behalf are nonetheless responsible for ensuring that those fee payments are kept
current and are also responsible for any outstanding payments for the school.
an I accept the above mentioned terms and conditions.
Legal R epresentative Signature THE BRITISH SCHOOL, QUITO STUDENT PERMISSION FORM
I ________________________ parent/guardian of
___________________________hereby give permission for the following
medications to be administered by the BSQ nurse should the need arise.
1. Insect repellent …………………………………………………………….
2. Balm to soothe insect bites/stings……………………………….
3. Ibuprofen…………………………………………………………………….
4. Paracetamol………………………………………………………………….
5. Cream for bruises/bumps…………………………………………. 6. Disinfectant to clean scratches or cuts.
Photographs
I______________________________, parent/guardian of
_________________________Hereby give permission for photographs taken by
the BSQ to be used in promotional materials and/or the school website.
Excursions
I________________________, parent/guardian of
______________________________Hereby give permission for my child to attend
School excursions and incursions within a 20km radius of the School.
ANTES DE USAR O PRODUTO LEIA O RÓTULO, A BULA E A RECEITA E CONSERVE-OS EM SEU PODER. “É OBRIGATÓRIO O USO DE EQUIPAMENTOS DE PROTEÇÃO INDIVIDUAL. PROTEJA-SE” “É OBRIGATÓRIA A DEVOLUÇÃO DA EMBALAGEM VAZIA.” CLASSIFICAÇÃO TOxICOLÓGICA III - MEDIANAMENTE TÓxICO CLASSIFICAÇÃO QUANTO AO POTENCIAL DE PERICULOSIDADE AMBIENTAL III - PRODUTO PERIGOSO AO MEIO AMBIENTE
All students newly admitted to Dwight School Seoul must complete and submit this health form prior to the first day of school. Page 3 of this form must be completed by a physician. The family is welcome to select a physician outside of Korea. If any of the information provided on this form changes during the school year, please notify the school Nurse immediately. Student Information Medica
Application Form – Primary