MY 1ST INTERNATIONAL Assess

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AN INITIATIVE OF SPM Educational Group

POWERED BY M AT H +
a numerical sTory

www.myfirstschool.asia | CANADA | INDIA | UK | USA

©2012 MFI Educators Pvt. Ltd.
 My 1st International Preschool Childs
STUDENT ENROLMENT APPLICATION (2012 – 2013) Recent
Photo
OFFICE USE ONLY
Reg. No: -------------------------------
For enrolment in ___________________
Reg. Dt: ------------------------------- Month / school year General Details (Part-
Reg. Receipt No: 1)
---------------------------
STUDENT INFORMATION
Remarks: ------------------------------
Name ______________________________ ______________________ Male  Female 
-------------------------------------------
Family Name First Name
Services Required:
Date of Birth___________________ Nationality (ies) _______________________________________
 Extended Daycare
Country of Birth _______________ Language Spoken at home _________________________________
 Transport
Home Address ________________________________ ______________ _______________________
 Meals
DOCUMENTATION CHECKLIST Street Postal Code Town/ City
 Registration Fee Receipt Guardians Telephone _________________________________, ________________________________
 Duly Filled Enrollment Application Guardians Email ______________________________________________________________________
 Duly Filled Students Medical History Guardians Last qualified education _______________________________________________________
 Duly Filled Permissions & NOC’s Guardians Professions _________________________________________________________________
 Copy Of Immunization Records
Guardians Annual Income_______________________________________________________________
 1 Recent Passport Sized Photo
Grade for 2012 – 13 (circle) DC/CC PG Nr KG1 KG2
 Copy Of Last Report Card

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 My 1st International Preschool
STUDENT ENROLMENT APPLICATION (2012 – 2013)

General Details (Part-2)

PREVIOUS SCHOOL (last 2 schools)
Name of School Country Dates Attended

________________________________________________________ __________________________ _______________________________

________________________________________________________ __________________________ _______________________________

Has a grade/class / year ever been repeated? Yes  No  or skipped? Yes  No 

Does the student, to your knowledge, have any particular learning disabilities? Yes  No 

LANGUAGE BACKGROUND English German Gujarati Hindi Marathi Other

Native Speaker __________ __________ _________ _________ __________ _______________

How many year __________ __________ _________ _________ __________ _______________
No knowledge __________ __________ _________ _________ __________ _______________

EMERGENCY CONTACT
Please provide a daytime emergency contact name and telephone number (other than parents):
Name: ______________________________________________________________ Tel. _________________________

www.myfirstschool.asia ©2012 MFI Educators Pvt. Ltd.

 My 1st International Preschool
STUDENT ENROLMENT APPLICATION (2012 – 2013)

Permissions &
NOC’s
PERMISSION & NOC.
My 1st International Preschool has my permission to use photographs of the above- named student for marketing purposes. Such photographs
may appear in newspaper, magazines, brochures, slide shows, or other publicity materials without any compensation.
 Yes  No
My 1st International Preschool has my permission to take my child / kid on field trips.
 Yes  No
My 1st International Preschool has my permission to give edible foods to my child / kid as a part of preschool curriculum.
 Yes  No
My 1st International Preschool has my permission to take my child / kid to the schools doctor in case of an emergency, during school hours.
 Yes  No
My 1st International Preschool has my permission to let my child / kid play with / in water, sand as a part of preschool curriculum.
 Yes  No

Signature: ___________________

www.myfirstschool.asia ©2012 MFI Educators Pvt. Ltd.

 My 1st International Preschool
STUDENT ENROLMENT APPLICATION (2012 – 2013)
Medical History (Part-

Student’s Name: ______________________________________________ Date of Birth: _________________

1)
Note: Medical history is to be completed by a parent or guardian in consultation with their family doctor.

Height of your child ___________________________________________ (CMs)

Weight of your child ___________________________________________ (KGs)

Does your child have any of the following problems? Please  all those apply.
 Asthma  Diabetes  Hyperactivity  Known allergies
 Kidney Trouble  Any handicaps  Blood Disorders  Behavior problem
 Convulsions or seizures  Rheumatic fever  Contact with tuberculosis
 Known vision and hearing loss  Other ___________________________________________
 
Other health problems?
____________________________________________________________________________________________________________________
 
Has your child had any operations, serious accidents, or hospitalizations?
 Yes  No Explain: ____________________________________________________________________________________

www.myfirstschool.asia ©2012 MFI Educators Pvt. Ltd.

 My 1st International Preschool
STUDENT ENROLMENT APPLICATION (2012 – 2013)
Medical History (Part-2)

Does your child take medications?

 Yes  No Name of medication: ___________________________________________
 
Please  any of the following childhood illnesses your child has had:
German measles  Measles  Mumps  Polio
Whooping cough  Diphtheria  Chicken Pox Tetanus
 
Has your child had any dental problem and / or toothaches?
 Yes  No
 
Has your doctor recommended any restrictions of activity for this child?
 Yes  No
 
Name of your child’s doctor or clinic: ____________________________________________________________________________________
Address: _______________________________________________________________________________ Phone: ____________________

Signature: ___________________

www.myfirstschool.asia ©2012 MFI Educators Pvt. Ltd.

 My 1st International Preschool
STUDENT ENROLMENT APPLICATION (2012 – 2013)
Declaration

PARENT INFORMATION
Father (or male guardian) ___________________________ ____________________ Mobile No. ____________________________________
Family Name First Name
Nationality (ies) ______________________________ Native language _________________________________________
Mother (or female guardian) ___________________________ ____________________ Mobile No. _________________________________
Family Name First Name
Nationality (ies) ______________________________ Native language _________________________________________

PARENTAL AUTHORITY
Please indicate who is legally responsible for the student named in this contract:/ Student lives with

 Father/ Guardian  Mother/ Guardian  Both Parents

DECLARATION
I, parent /guardian of ___________________________________hereby declare that all the information provided in the application form is true
and correct and has been offered freely. Furthermore, I hereby authorize the transfer of this information to the school’s electronic database.

Name _____________________________________ signature ____________________________ Date ____________________

www.myfirstschool.asia ©2012 MFI Educators Pvt. Ltd.