Microsoft word - applic_form

B e l i e f | M o t i v a t i o n | I n s p i r a t i o n | S u c c e s s Telephone: (+265) 01 756 364 / 756 894 / 756 984 / 756 631 This application form must be completed in full and accompanied by: Certified passport or birth certificate copies for the prospective student One passport size photograph of the prospective student Certified passport copies for the parents/legal guardians Completed confidential health questionnaire A minimum of one full year’s report from the previous school A completed head teacher recommendation form from the previous school PARTICULARS OF PROSPECTIVE STUDENT (PLEASE PRINT) Date of Birth (DD/MM/YY) : . Sex (M/F) : . Country of Birth: . Nationality (passport/birth certificate): . Religion (optional): . Tick the box which best describes your child’s use of the English language: Other schools attended in the last two years: (Please tick – at least one year’s school report is essential) Has your child ever been identified as having Special Educational Needs? (If “YES”, please give details on a separate sheet of paper) Requested date of entry into school.…………………………. Requested year group to be admitted to …………………………………………………………………. Name(s) and classes of siblings already in this school:.………. . The family registration fee is payable unless there is already a brother or sister (not cousin or other relative) already enrolled at the school. For school office use only: Fee Tier Allocated: PARTICULARS OF PARENTS OR LEGAL GUARDIANS (PLEASE PRINT) (Names of both parents/guardians are required for the Board of Trustees electoral roll) First name(s) (Father/1st guardian)……………. Residential/employment status if not Malawi citizen: Do you pay income tax in Malawi on any portion of your salary? First name(s) (Mother/2nd guardian) )……………. Residential/employment status if not Malawi citizen: Do you pay income tax in Malawi on any portion of your salary? P.O. Box . Residential address (area/plot no.) . Mother’s work: ……….……………….…. Mother’s Cell…………………………………… E-mail: Father……………………………………………………. Mother…………………………….…….……………………… OTHER (Please specify) .……………. I/we,. being the parents/legal guardians of the above named prospective student, do hereby accept full responsibility for the payment of school fees for the student, should the application prove successful, at the rate determined by the school and at the time required by the school. I/we further declare that all the information supplied with this application is correct, and I/we understand that if material inaccuracies are revealed at a later date, any decision to admit the child will be reviewed by the school. . IF THE PERSON COMPLETING THIS FORM IS NOT THE PARENT OR LEGAL GUARDIAN: Surname .………. First name(s) .……………………………….…….………. Occupation or position .………………………………………………….…….…. Relationship to prospective student, parent or legal guardian: .……………………………………………………. Employer: .……. Position .……………….…………………. Postal Address: .…. Telephone:.……………………….…. Why is this application not being made by the parent or legal guardian? .…………………………. .……………………………. .……………………………. .……………………………. .……………………………. AGREEMENT BETWEEN BMIS AND PARENT OR LEGAL GUARDIAN agree that, if the child named above is admitted as a student of BMIS: 1. s/he shall observe and be subject to the regulations, policies, by-laws and discipline of the school. 2. s/he shall attend all sessions required by the school during school terms, including Saturdays, extra sporting days when selected for a school representative team or when selected to participate in cultural events outside normal school hours. S/he will arrive punctually for any school day or event. 3. s/he shall wear the prescribed school uniform in a clean and tidy manner when attending school or school-sponsored events. S/he shall not at any time wear the school uniform in part, or in any manner that may bring the uniform into disrepute. S/he shall keep her/his hair trimmed and tidy at all times. 4. I have accepted full responsibility for payment in advance of all school fees, deposits, levies and extra charges which may fall due, and I understand that failure to pay may result in my child’s temporary or permanent exclusion from the school. 5. I will keep the school informed of any change in address or telephone numbers, either residential or business, this being essential in cases of emergency. 6. I will notify the school one calendar month in advance should I intend to withdraw my child from the school. If and only if such notice is given, any balance of the Deposit will be refunded. Further, if and only if such notice is given, half the term’s fees will be refunded if the date of withdrawal is during the first half of the term. 7. I will notify the school with all details should my child ever be left in the care of another person while the parents/legal guardians are both absent from home. 8. I will attend parent interviews when requested and will, to the best of my ability, meet reasonable requests from teachers to help my child overcome learning difficulties. 9. I will act on advice of the Headteacher regarding any identified need for external professional assessment 10. in the event of accident or serious illness of my child during the official school day, or at such time that the successful candidate is participating in school-sponsored activity, and should all attempts to contact the undersigned be unsuccessful, the Director of school or his/her representative may seek medical treatment for the child, at his/her complete discretion, and I agree to pay all medical and related expenses. 11. I will notify the school immediately of any illness, accident, medical condition or any other circumstance (such as bereavement) which may affect my child’s physical or mental performance. 12. the school cannot accept liability for loss or damage to the possessions of the child while s/he is at school or on school-sponsored activities of any nature. Admission to the school is only valid after this application form and related documents have been completed and the registration fee and deposit paid. Tuition fees are due no later than ten school days after admission of the successful candidate. The school reserves the right to place any student in the class deemed most appropriate by the relevant Head of School. To gain admission the candidate must successfully complete and pass the entrance test. In certain cases parents will be informed that admission is conditional and subject to annual review. Admission will be in accordance with the school’s published Admissions Policy, and negotiation will not be entered into. Blood group (you are advised to have this tested if not known): __________ 2. Contacts in case of medical emergency Please give all possible numbers for us to try and reach you 1st parent/guardian full name: ___________________________ Numbers: _____________________ 2nd parent/guardian full name: __________________________ Numbers: _____________________ Any other names and emergency numbers: ____________________________________________ 3. Family medical and emergency arrangements Doctor: ________________________________________ Membership of any medical organisations or schemes (e.g. MRS, MASM) Please give principal membership name and account number, plus any emergency instructions. In an emergency we will always try to contact you or, if that fails, your family doctor. We will also attempt to carry out any emergency instructions given by you. If we cannot contact you and cannot for any reason follow your instructions, we will take whatever action we judge to be in the best interests of your child while s/he is in our care, including call-out to MRS. Any charges incurred will be passed on to you. Please list any allergies or medical conditions you are aware of that affect your child. Allergies and adverse reactions (e.g. to penicillin, insect stings, certain foodstuffs etc.) __________________________________________________________________________________ Medical conditions (e.g. epilepsy, diabetes, asthma etc.) __________________________________________________________________________________ __________________________________________________________________________________ Recent serious illnesses, operations or accidents __________________________________________________________________________________ (Continue on a separate sheet of paper if necessary) Regular medication, including anti-malarials, taken by your child – if not taken at regular times, please explain when it is taken (e.g. “during an asthma attack”) Product: __________________ Dosage: _________________ Product: __________________ Dosage: _________________ Is this to be given by the school staff? If so please attach details of what is used and how to administer at school. No medication will be administered by staff unless provided, with full instructions and permission, by parents/guardians. When should they be worn? (E.g. “all the time”, “only for reading” etc) ________________________ Does your child have any hearing difficulties? __________________________________________________________________________________ Different countries have different vaccination schemes. Please give whatever details you can. Vaccination scheme – which country? __________________________ Please attach a copy of any vaccination records or certificates. Which countries has your child visited in the past 12 months? ______________________________ You do not have to give us this information, but if you do it may give us a better understanding of your child’s medical history. Father’s nationality: ______________________ Mother’s nationality: ______________________ Names and dates of birth of brothers and sisters at BMIS Medical history of close family (parents, brothers and sisters) Do any family members suffer from allergies, asthma, diabetes or hereditary conditions? Give details. Have any family members recently suffered from serious illness (e.g. tuberculosis)? Give details. Confidentiality policy Thank you for taking the time to fill in this form. The information is and will remain confidential to the relevant School Staff. Signature and authority to act in emergency I confirm that the above information is correct as far as I know and, as parent/guardian of the student named at the top of this form, I authorise the School to act as outlined in box 3 above. Full name: __________________________________________________________________

Source: http://www.bmis.mw/wp-content/uploads/2012/05/Applic_Form_May2012.pdf