HCIK Online Admission Form

Hana Student Application Form
Basic Information (Required)
Application Date*

DayMonthYear
Date
Applying for Grade*

Pre-school 1 (age 1-2)Pre-school 2 (age 2-3)K-1 (age 3-4)K-2 (age 4-5)K-3 (age 5-6)
Academic Session*
Name of the student (In English)*

First NameMiddle NameLast Name
Thai spelling name of the student (For Thai Nationals Only)

First NameMiddle NameLast Name
Nick Name (If any)
Date of Birth*

DayMonthYear
Birth Date
Age*
Nationality*
Gender*
Home Country Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Mother's Information (Required)
Mother's Name*

First NameLast Name
Occupation*
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Email*

Confirmation EmailRe-enter E-mail address for verification
Father's Information (Required)
Father's Name*

First NameLast Name
Occupation*
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Email*

Confirmation EmailRe-enter E-mail address for verification
Guardian's Information (Optional)
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Please enter a valid phone number.
Email

Confirmation EmailRe-enter E-mail address for verification
Emergency Contact 1 (Required)
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Emergency Contact 2 (Optional)
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Physical Ailments (Required)
Physical Ailments?*

YesNo
If yes, please specify
Any Allergies?*

YesNo
If yes, please specify
Special Needs or Requests
Background Information (Required)
1. Has your child ever attended school before?*

YesNo
2. What is your child's first language?*
3. What other languages can your child speak? (Optional)
4. Language spoken at home? *
5. Has your child ever been referred for educational or psychological testing?*

YesNo
If yes, please specify
6. Are you concerned your child may need support in regard to learning behavior or emotional problems?*

YesNo
If yes, please specify
8. Does your child have hearing aid or hearing difficulties?*

YesNo
9. Does your child have hemophilia?*

YesNo
10. Does your child wear glasses?*

YesNo
11. Does your child have heart or joint problems?*

YesNo
If yes, please specify
12. Does your child suffer from asthma?*

YesNo
13. Does your child take regular medication?*

YesNo
If yes, please specify
7. Can the school nurse give Paracetamol and common cold medication for minor aches or fever?*

YesNo
14. I authorize Hana Christian International Kindergarten School to use photos of my child in the classroom, school publications including school official website, school packets, handbooks and school Facebook.*

YesNo
Visa
15. My child requires Student ED-Visa.*

YesNo
Name of Thai Consulate applying for visa (child)?
16. I require Guardian Non-O Visa.*

Yes, MotherYes, FatherNo
Name of Thai Consulate applying for visa (guardian)?
Documents for registration (Required)
Child's Birth Certificate*

Cancelof
Copy of Child’s Immunization Record*

Cancelof
Child's Birth Certificate Translated to English (Foreigner)

Cancelof
Child's Passport Scanned (Foreigner)

Cancelof
Mother's Passport Scanned (Foreigner)

Cancelof
Father's Passport Scanned (Foreigner)

Cancelof
Child's Photo (4x6cm for foreigner)*

Cancelof
House Registration (For Thai National's Only)

Cancelof
Agreement

Agreement & Authorization
Parent Agreement Form
(Please read carefully before signing)
HCIK is permitted to require the parents of prospective and re-enrolling HCIK students to sign this parent agreement form.

1. I certify that the information contained in this application and supporting documents is complete and correct. I understand that Hana Christian International Kindergarten reserves the right to reassess and withdraw any offer of admission when an application is discovered to be incorrect or incomplete. Any additional information that I have regarding my child’s abilities or special needs has been included.

2. I understand that acceptance and enrollment constitute a contract to pay the entire year’s fees as specified on the fee schedule, and I understand that there is no reduction or refund for absence or dismissal unless covered by the tuition refund policy. I have received and read the fee schedule and agree to be responsible for paying the fees according to the schedule set by Hana Christian International Kindergarten.

3. I understand that my child’s name and photos may be used in school materials and media; including but not limited to award presentations, ceremonies, newsletters, websites, videos, etc., unless I specifically request otherwise.

4. If my child is determined to need ESL support, I understand that my child will receive ESL services, and that I will be required to pay the ESL fee.

5. I understand that as a Christian School the Teachers/School will teach according to Christian Morals and values.

ข้าพเจ้ายอมรับเงื่อนไขและหลักสูตรที่ทางโรงเรียนอนุบาลนานาชาติฮานาคริสเตียนได้กำหนดไว้ ข้าพเจ้าเข้าใจว่าโรงเรียนอนุบาลนานาชาติฮานาคริสเตียนเป็นโรงเรียนคริสเตียนคุณครูจึงสอนนักเรียนตามหลักการและคำสอนของคริสเตียน.

By completing this application, you are registering an intention to enroll the child named in this form at the school. I hereby agree to the curriculum of Hana Christian International School.
Do you understand and agree to the terms listed above?*

Yes, I understand and agree to the terms listed above.
Parent's Signature*

Clear
We would like to thank you for trusting us with the care of your children. We are dedicated to give them the encouragement, love, and support they need to learn and grow. We appreciate the opportunity to be part of the stimulating and wonderful years in your children lives.

Blessings,
Hana Christian International Kindergarten
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Hana Student Application Form

Basic Information (Required)

Mother's Information (Required)

Father's Information (Required)

Guardian's Information (Optional)

Emergency Contact 1 (Required)

Emergency Contact 2 (Optional)

Physical Ailments (Required)

Background Information (Required)

Visa

Documents for registration (Required)

Agreement