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Microsoft word - admissions form (draft)-11.docTENBY SCHOOLS MALAYSIA
APPLICATION FOR ADMISSION
Before submitting the Admissions Form to the specific school in Tenby Schools Group, please check
that all documentation listed below has been attached to ensure smooth processing.
1. Application for Admission Form
Please complete the Admissions Form. All sections must be completed. 2. Photographs
A most recent colour passport size photograph (35mm x 50mm with white background) of student, father, mother and guardian (if applicable). 3. Passport
Passport copy must include the cover, photo, particulars, expiry and visa page of student, father, mother and guardian (if applicable). The original must be submitted along with the copy for verification. 4. Birth Certificate
Student's birth certificate copy must include full particulars including parent's detail, and place of birth. The original must be submitted along with the copy for verification. 5. Identity Card (Malaysians only)
Identity Card copy must include front and back for student, father, mother and guardian (if applicable). The original must be submitted along with the copy for verification. 6. Visa (Non-Malaysians only)
It is compulsory that all foreign students obtain relevant visa upon acceptance by the School as mandated by The Immigration Department of Malaysia requires. The visa application will be done by the School but the cost to be borne by parents.
7. School Reports
A copy of student's most recent school report. The original must be submitted along with the copy for verification. If the report is in a language other than English, please have it translated and verified True Copy. Students who require or may require learning support must provide the School with a recent Educational Psychological Report, Speech/Language assessment reports, and/or Special Needs Evaluation (where applicable).
8. Medical & Health Records
If the student has a medical condition that requires attention, please give further details and a copy of most recent medical report. Please also include other pertinent information such as immunisation record and blood group.
9. Guardian's Details
This is applicable for students who are staying with an appointed Guardian. Parents must provide the School with the Guardian's photo, Passport/IC copy, contact details, and a letter confirming the appointment.
10. Data Protection Consent Form
Please complete the Data Protection Consent Form. All sections must be completed. 11. Application Fee
A non-refundable Application Fee is required upon a successful submission of an application. Payment may be made in Cash, Cheque or Banker's Draft in RM (Ringgit Malaysia). Application is only deemed complete when the School has received the above documentation.
APPLICATION FOR ADMISSION
☐ IPOH, PERAK
☐ SETIA ECO PARK, SELANGOR
☐ MIRI, SARAWAK
☐ SETIA ECO GARDENS, JOHOR
☐ SETIA ECOHILL, SELANGOR
☐ OTHER _
(PLEASE USE BLOCK LETTERS THROUGHOUT) SECTION 1: STUDENT DETAILS
Student's Passport ☐Male ☐Female 35mm x 50mm with White Background Birth Certificate No.: Ethnicity (Race): Correspondence Address (if other than home): PREVIOUS SCHOOLS (Please list most recent first)
Reason for Leaving
SECTION 2: FAMILY DETAILS
Name (As in Passport / IC): Title (Mr / Mrs / / Ms / Dr / Tan Sri / Dato' / Datuk / etc.): Passport / IC No.: Father's Passport 35mm x 50mm with White Background Company Address: Name (As in Passport / IC): Title (Mr / Mrs / / Ms / Dr / Tan Sri / Dato' / Datuk / etc.): Passport / IC No.: Mother's Passport Size 35mm x 50mm with White Background Company Address: Parent's Marital Status: ☐ Married ☐ Separated ☐ Divorced ☐ Widowed ☐ Others (please specify): SIBLING(S)
Date of Birth
SECTION 3: GUARDIAN DETAILS
GUARDIAN (Other than parents, if applicable)
Name (As in Passport / IC): Title (Mr / Mrs / / Ms / Dr / Tan Sri / Dato' / Datuk / etc.): Relationship to Student: Guardian's Passport Passport / IC No.: 35mm x 50mm with White Background Company Address: SECTION 4: STUDENT INFORMATION
Please confirm whether the student has been diagnosed / is suspected of any of the following: ADD – *High / Low Functionality (*please circle applicable) Dyslexia – *High / Low Functionality (*please circle applicable) Extreme Hyperactivity Others (please specify): If yes, please give details: Has the student ever received learning support? If yes, please give details: Is the student undergoing any form of therapy/counselling? If yes, please give details: Does the student have any: a) Learning difficulties b) Psychological needs c) Physical disabilities If yes, please give details: Has the student ever received special education services? If yes, please give details: SECTION 5: PAYMENT DETAILS
(To be completed if payment is made by other than parents) Schools fees paid by: ☐ Individual ☐ Company SECTION 6: MEDICAL & HEALTH CONCERNS
Please complete the form concisely and accurately. If question is not applicable, please indicate appropriately. Failure to disclose your child's accurate medical information may result in unnecessary delay when seeking medical treatment. ALLERGIES
Does your child have any allergies? If yes, please give details (including treatment): Does your child have any allergies? If yes, what triggers the asthma and what are the symptoms: List any medications your child takes for asthma, including dosage and frequency: DIABETES
Is your child diabetic? If yes, which type? Please describe the management, including medications: EPILEPSY
Does your child have epilepsy? If yes, which type? ☐ Grand ☐ Petit Mal What is the frequency of seizures? Please list medications, including dosage and frequency: OTHER MEDICAL CONCERNS
☐ Past Surgeries / Fractures (please include dates) ☐ Others (please specify): Please describe any other conditions or concerns that the school should be aware of: MEDICATIONS
Does your child regularly take any medication either at home or during school hours? ☐ Yes ☐ No If yes, please list below: Name of Medication
PERMISSION FOR MEDICATION
Please notify the Nurse if you wish to store your child's medication in the Medical Centre, whereby the
medication(s) will be given to your child as prescribed.
The nurse has permission to administer the following medication if judged appropriate: (with pseudoephedrine) ☐ Yes ☐ No Charcoal Tablets Panadol Menstrual Optrex Eye Drops Ventolin Inhaler Oral Rehydration Salt Panadol (Paracetamol) ☐ Yes ☐ No Zyrtec (antihistamine) LIMITATIONS
☐ This student may participate fully in school physical activities including competitive sports, PE
and dance classes.
☐ This student has the following physical restrictions:
If a doctor makes any recommendations or restrictions during the school year regarding your child's
health, please submit the recommendation or certificate to the school as soon as possible. Otherwise,
the child will be considered "physically fit" and is able to participate in Physical Education (PE)
activities required by the curriculum and in other activities that may be part of the school's
Parent / Guardian Signature:
ADMINISTRATION OF SCHEDULED VACCINATIONS AND IMMUNISATIONS
Please fill in the following schedule with the dates of each vaccination and immunisation that your
child has received.
1st Booster 2nd Booster 3rd Booster Chicken Pox / Varicella Japanese Encephalitis JBE I acknowledge that the information pertaining to my child's medical and health record is accurate and correct to the best of my knowledge. Parent / Guardian Signature: PERMISSION FOR EMERGENCY CARE
I hereby give permission for emergency measures to be initiated for my child in case of serious injury or illness. This includes ambulance transportation to a hospital, with the understanding that I will be contacted as soon as possible. Please indicate preferred hospital below: Note: If a preferred hospital is not indicated, the school will send your child to the nearest hospital (government/private) available. Name of Hospital: Address of Hospital: Parent / Guardian Signature: EMERGENCY CONTACTS
If either parent is not reachable, please call: Relationship to Student: SECTION 7: APPLICATION FOR SECURITY ID TAGS
Siblings (if any): Applicant's Name
Passport / IC No.
Relationship to Student
* For parents, the first card is issued free. Please enclose the following together with the application:
One (1) passport size photo for each applicant For additional tags, please also attach a photocopy of Passport / IC / Work Permit FOR OFFICE USE
☐ New Applicant (2 free ID for parents) ☐ Payment (if any): ☐ Additional Tag (RM20 each) ☐ Replacement of Lost ID Tag (RM20) SECTION 8: APPLICATION FOR CAR STICKERS
Car Registration No.
* Only two car stickers free PER FAMILY (maximum four per family); car stickers are not transferable FOR OFFICE USE
☐ New Applicant (2 free stickers) ☐ Payment (if any): ☐ Additional Stickers (RM20 each) ☐ Stickers Issued Parent / Guardian Name: Parent / Guardian Signature: TERMS AND CONDITIONS OF ADMISSIONS INTO TENBY SCHOOLS, MALAYSIA
In making this application, I/We undertake and agree:
1. To pay a non-refundable Application/Registration Fee with this application form as required for
enrolment into the School. 2. To pay all fees before the commencement of the School term (there are 3 terms a year). The School reserves the right to impose a late payment charge of 5% per annum on all outstanding fees which has not been paid by the 15th day from the commencement of the School term. The School reserves the right to refuse entry to any student and/or treat this contract as terminated without prior notice to the parents/students. 3. To give, in writing, on or before the first day of term, notice of a student leaving the School at the end of the term. Failure to do so will result in the forfeiture of the deposit. 4. That should the student be offered a place at the School, he/she participates in all normal educational activities including physical education and sports activities, scientific work, subject folios, projects, enrichment or remedial programmes, swimming lessons, educational visits and outings. This includes an undertaking to wear the uniform and support the school in the achievement of its aims and objectives. 5. That the School reserves the right to discipline, suspend or dismiss any student whose lack of academic progress or whose behaviour is considered by The Principal to be unacceptable or an embarrassment to the School. When any student is suspended or dismissed, the School shall retain by way of liquidated damages, and the parent shall forfeit all entitlement to any fees paid with respect to the student. 6. To inform the School of any change of address, contact details or alteration of personal details from the year of entry for the student. 7. To abide by changes made to the school policies, regulations, fees and schedule by the School at the School's sole discretion. 8. That the School reserves the sole discretion to terminate the contract herein with the parent/student at any time if such termination is considered to be in the best interest of the School. 9. Data Protection: By signing this form, the Parents/Guardian understand and agrees to allow the
School to process personal information that includes financial and sensitive information, and not limited to: School admissions and attendance registers Students' curricular, disciplinary and medical records Reports to parents on achievements of their children Records in connection with students entered for public examinations Personal information for teaching purposes (assessment data, teacher mark books) 10. The School may use the personal information for the purposes below, but not limited to: For admissions into Tenby Schools For communication, advertising and news For general administration and record 11. The School may disclose pertinent information to certain third parties if deemed necessary by the 12. The Parents may request for the Student's records to be disclosed by way of written request and the School will approve any practical and reasonable request (at the School's discretion). 13. Information Communication Technology (ICT) Policy: The Student must adhere to the ICT
Policy as set by the school. The Parents and the Student will be required to ensure that the usage of the School's ICT systems is strictly for educational and academic purposes only. 14. A breach or suspected breach of ICT policy may result in the temporary or permanent withdrawal of the School's ICT hardware, software or services from the Student. Any policy breach is grounds for disciplinary action and may also lead to criminal or civil proceedings. 15. Model Release: The School may in the course of the Student's education take photographs of
the Student at school or while doing school activities in/out of school. 16. I/we hereby grant Tenby Schools the irrevocable right and permission, in connection with the photographs taken of the Student, or in which they made be included with others, the following: The right to use and reuse, said photographs in whole or in part: either by themselves or in conjunction with other media, in any medium or form of distribution, for purposes of promotional and advertising uses for a period of not more than five years from the date of this form; and The right to copyright said photographs only for use by Tenby Schools and/or subsidiaries and associate companies of Tenby Schools. ☐I/we hereby release and discharge Tenby Schools from any and all claims, actions and demands arising out of or in connection with the use of said photographs. ☐ I/we have read the foregoing and wish to opt out of the Model Release clause. 17. Indemnity: I/we hereby indemnify the School, its officers and employees against any and all
claims arising from any injury to the student whilst participating in any School activity, or while on School property or while travelling to or from school premises. 18. I/we understand and agree that in the event of an emergency, the School will make every effort to contact the parents or guardian. However, if this is not possible, the student will be taken to either his/her family doctor (if known) or to a suitable hospital, approved by the School, for treatment. The parent/guardian will reimburse the school for any expenses/payment incurred to the hospital/clinic concerned. Signature of Father / Mother / Guardian
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