Admission Form Student Information Student Name* Preferred Name Gender MaleFemale Age* Date of Birth* Grade Level* Address* Nationality Religion Passport Number or Birth Certificate Student Photo Photo size max 5mb Academic year Applying for Preferred Month of Enrolment Siblings Information Name/s of Sibling (Separate the siblings name by a comma) Are they attending Springdale International School? Parent Information Father's Name* Father's Occupation* Phone Number* Email Father Image Photo size max 5mb Mother's Name* Mother's Occupation* Phone Number* Email Mother Image Photo size max 5mb Emergency Contact Information Contact 1 Name* Relation* Phone Number* Email Contact 1 Image Photo size max 5mb Contact 2 Name Relation Phone Number Email Contact 2 Image Photo size max 5mb Other Information Permission for Emergency Treatment & Administering Medication Is this the applicant's first year of school? Name of prior School Address (City, State), Phone, Grade(s) & Year(s) Permission for Emergency Treatment & Administering Medication I give my permission for the staff at Springdale International School to administer the following medication to my child if deemed necessary. Medicine prescribed by a doctor (that must be taken while the child is in the care of the school or pre-school) No other medications will be administered except those listed above. If your child becomes ill, you will be notified. It is the parent's responsibility to make sure the child's emergency card is current I agreedisagree Dress code Agreement I am aware and acknowledge the dress code police for Springdale International School. My child will be present each day, compliant with the appropriate dress code. I understand that if my child is not dressed in the proper uniform or ion violation of dress code guidelines I will be notified to correct the infraction. Failure to correct the infraction or repeated offenses may result in a disciplinary action including suspension. I agreedisagree Field Trip Permission Slip I give permission for my for my child to participate in school sponsored field trips. (Note: notices will be sent home with your child prior to each trip with detailed information and specific permission but this act as permission for your convenience.) YesNo Photo/Video Release I hereby give permission for my son/daughter to be photographed or videotaped while at Springdale International School. I realize that the photo may be published in the newspaper, a magazine, the school's website and social media pages (Facebook/Instagram/Twitter/YouTube) or other publication. The vide may be used for informational or educational purposes regarding the programs or curriculum of Springdale International School. Photos/Videos may not be used or distributed for personal use. I agreedisagree School Directory Springdale International School may post an online School Directory with the names, addresses, emails and phone numbers of our SDIS families. We would like our contact information include in the School Directory. YesNo School Policies 1. Have the following school policies, as outlined in the SDIS or Parent-Student Handbook, been explained to you YesNo 2. I have read and agree to follow the guidelines and policies as set forth in the SDIS or Parent-Student Handbook YesNo 3. We will make every effort to make sure our child is in attendance at SDIS when he/she is admitted. YesNo 4. We will ensue our child's attendance at all curricular activities of Springdale International School. YesNo 5. We will pay the registration and tuition as required. YesNo 6. We understand that if our child transfers at any time before or during the school year, only the security deposit will be refunded at the end of the Academic Year, provided that all dues have been cleared. YesNo 7. I also understand that failure to abide by any of these guidelines may result in the expulsion of my child from Springdale International School. I also realize that I will be held liable for any outstanding accounts. I understand that my child's educational records from enrollment at SDIS will not be released until all accounts are paid in full. YesNo Medical Information a) Please indicate if your child has had any of the following Note: Please specify the date of the diagnose. Meningitis YesNo Scarlet Fever YesNo Mumps YesNo Whooping Cough YesNo Tuberculosis YesNo Diabetes YesNo Rheumatic Fever YesNo Diphtheria YesNo German Measles YesNo Poliomyelitis YesNo Chicken Pox YesNo Epilepsy YesNo Heart Disease YesNo Kidney Disease YesNo Has your child's condition been diagnosed by a medical practitioner? YesNo Has your child been prescribed any form of medication to assist with this condition? YesNo If yes, what is/are the medication(s)? Has your child been diagnosed with any form of SEN (special education need)? YesNo If yes, what is the nature of the need? Does your child have any other condition(s) (Please specify) If you have answers Yes in any of the above, Physician's report is required. b) Please Specify: Any allergies or asthma(include food or drug allergies) Any serious injuries or surgeries Does your child take any medicine regularly? If YES please furbish the following: Does your child wear glasses? YesNo Has your child ever had any hearing problem? YesNo Language Spoken What is your child's mother tongue? What language(s) are spoken at home? Would you like the student to receive the "Additional Language" service? YesNo In the event of Springdale International School gaining the service of a School Doctor, I give permission for my child to receive a medical examination Please provide the following Documents below with the admissions form: 1. One passport copy of the student. 2. One passport copy of each parent 3. Two passport size photographs of Student. 4. Two passport size photo of each parent. 5. One copy of National ID or equivalent of each parent. 6. One passport size photo of each guardian of the student. 7. Birth certificate of student. I confirm that all the information provided above is accurate. Δ
