Enrollment Form Student’s full name
Nick name
Birthdate
Age
___ male years
Place of birth
months
___ female
MyKid no. (if any)
Language spoken at home
Child’s understanding of instructions in English ____ None
____ Fair
____ Good
____ Fair
____ Good
Child’s spoken English ____ None Father’s name
Occupation
Contact number Mother’s name
Occupation
Contact number Home address
Office address (either parent)
Home phone number
Office phone number Fax number
For school use only I
Date Received Date of Enrollment Date of Interview First Day of Class Remarks Student no. assigned
60 jalan bu 1/9 bandar utama t/f. +603 77253225
47800 petaling jaya selangor malaysia www.casamontessori.com.my
Enrollment Form Parents’ Questionnaire Please complete the following questionnaire. This will enable us to better understand the needs of you and your child in order for us to plan your child’s programme.
Child’s Health Information General health Number of days ill last year (approx.) Has you child been hospitalized before? If yes, please state the reason. Allergies (please complete the Allergy Information Form if your child has any allergy) Medications, if any Is your child free from communicable and infectious disease and able to participate in a group programme? Is your child able to participate in a normal outdoor physical activity? If no, please explain: Please let us know if your child has special needs so that we can provide assistance. * Please provide us a copy of your child’s immunization record.
Child’s Siblings’ Information Name
age
Others Is your child involved in other group participation activities? Please describe:
60 jalan bu 1/9 bandar utama t/f. +603 77253225
47800 petaling jaya selangor malaysia www.casamontessori.com.my
male
female
_____
______
_____
______
_____
______
Enrollment Form Child’s Profile Education Background Present/ previous school(s) experience
date enrolled
date withdrawn
Please explain reasons for changing schools in the past Describe your child’s academic strengths and subject preferences
Does your child have any clinically diagnosed learning differences? If yes, please specify diagnosis, date diagnosed & steps taken.
Parent’s Assessment of Child’s Development Physical (e.g. can jump off ground with 2 legs, can eat by self, can kick a ball and not lose balance, etc.)
Intellectual (e.g. can recognize 5 letters, can complete 5-piece puzzles within 5 mins, etc.)
Language (e.g. can speak in 2 or 3 word sentences, can understand verbal instructions well, etc.)
Emotional (e.g. will cry inconsolably when toy is taken away, is able to take ‘no’ for an answer when making a request, etc.)
Social (e.g. shy at first but warms up quickly, fear of strangers, can share toys with another child, etc.)
60 jalan bu 1/9 bandar utama t/f. +603 77253225
47800 petaling jaya selangor malaysia www.casamontessori.com.my
Enrollment Form
Child’s Characteristics/ Personality Describe your child.
Parent’s Objectives for Child In what areas (academic, social, emotional...) do your hope to see your child make the most progress? a. In 2 months
b. In 6 months
c. In 12 months
Child’s Routines List the activities that you play/ participate with your child. Activity e.g. Go to the park
Frequency/ Duration Once a week for 1 hour
Adult(s)/ sibling(s) mum, dad, baby bro
Do you have any concerns, fears, and doubts about raising your child or your child’s development? If yes, what are they?
Information provided will only be used for the on-going lesson planning & assessment of your child at school. Thank you for sharing with us.
60 jalan bu 1/9 bandar utama t/f. +603 77253225
47800 petaling jaya selangor malaysia www.casamontessori.com.my
Enrollment Form Important Notes: 1.
Enrollment is confirmed upon receiving of the student’s Enrollment Form and the full payment (term fee, deposit, admission fee, annual fee and other fees applicable).
2.
Fees paid are non-refundable and non-transferable.
3.
Fees are collected by the 1st week of the month that it is due.
4.
Deposit is due at enrollment. It is returned upon withdrawal, if a written notice is given to the school at least one month from the intended last day of school.
5.
Parents hereby agree to pay all the applicable fees upon signing the Enrollment Form.
6.
The school reserves the right to require withdrawal of a student in situations involving repeated or serious violation of school rules, or serious academic problems, or if a student’s influence is considered harmful or his/ her presence in the school is considered undesirable or if any material information contained in the Enrollment Form is incorrect. Any such decision will be made by the Principal. The school also reserves the right to require a student to withdraw for medical or psychological reasons, such decision to be made by the Principal in consultation with a physician and /or consulting child psychiatrist.
7.
A late payment fee of 5% of the total fees due will be added to all payments received after the first week of the month in which it is due. A returned cheque fee of RM 15 will be added to all payments returned by the bank unpaid.
8.
RM 5 will be charge for every 30 minutes that student is left at school past the programme hours.
9.
For obvious hygiene reasons, students showing symptoms of flu or cold cannot attend school until 24 hours after all the symptoms have stopped completely. Should the student contracted a contagious disease (e.g. chicken pox), s/he can return to school 5 days after all of the symptoms have stopped completely.
10.
We are unable to refund any fees paid, in the event that a student is unable to attend classes due to a medical leave or any type of leave.
11.
I understand that the teachers and staff at the school will do everything necessary to ensure the safety of my child at school and on school outings. I agree to indemnify and hold harmless Tadika Sri Sejati (Kids Love Learning & Casa Montessori), its controlling persons, directors, employees, staff and teachers from any and all personal injury and property damage claims and resulting judgements and expenses made by or on behalf of my child, including those based upon the ordinary negligence of such persons.
Parent/Guardian’s signature.....................................
Principal’s signature.........................................
Date …………………………
Date ……………………………..
60 jalan bu 1/9 bandar utama t/f. +603 77253225
47800 petaling jaya selangor malaysia www.casamontessori.com.my