DSSV Registration Form 2022

2022-2023 DSSV registration form
The Dutch School Silicon Valley is a registered Non-Profit Organization that depends on the time and talent provided by parents, volunteers and employees to realize the best educational experience for our students.
- Age : Students are welcome from their 5th birthday onwards.
- Tuition Contribution per student:
  - USD 1485 (USD 165/month) without employer reimbursement.
  - USD 2160 (USD 240/month) when you receive employer reimbursement.
  - Third child discount: 40% on the tuition for the third child.
  - School materials and books contribution: USD 50 / year
- Registration fee: USD 100 per family

Contact information

We would like to register one or more students (per family) for the 2022-2023 school year at the Dutch School Silicon Valley.
Contact Name

First Name Last Name
Contact Email *
example@example.com
Street Address
State *
City
Postal Code

Emergency Information
In case of an emergency we will contact the Primary Contact, if we cannot get hold of this first contact we will contact Secundary Contact. When both parents/legal guardians cannot be reached, we will contact the Emergency Contact provided to us in this form.
Primary Contact *

Primary First Name Primary Last Name
1.Cell phone number
Please enter a valid phone number.
1.Email address
example@example.com
Secondary Contact

Sec First Name Sec Last Name
2.Cell phone number
Please enter a valid phone number.
2.Email address
example@example.com
Emergency Contact

Emergency First Name Emergency Last Name
3.Cell phone number
Please enter a valid phone number.
Relationship
Relationship to student of 2nd Emergency Contact
I understand that, as standard procedure, my child(ren) will only be released to the persons registered in this form. I would like to add the following person(s) as possible adult(s) that my child(ren) may be released to, after I have given notice of this to the teacher (Grandma/Grandpa/Nanny etc). Please fill out their first and last name and relationship to the student.
Additional person
Relation to student
Authorization (in case of emergency)

I, hereby, authorize the Dutch School Silicon Valley (the “School”), and its board members, directors, officers, administrators, staff (a.o. teachers and teaching assistants), employees, volunteers and agents, to take any measures necessary for the protection of my child(ren) during the hours of the DSSV classes and events.
Signature *

Clear

For parents by parents: supporting, volunteering and donations

The DSSV is certified Non-Profit Organization run by parents, volunteers and paid employees. Our school depends on donations in time, talent and monetary means to provide the best education to our students. Let us know in what form you would like to participate in creating the best possible educational experience for our children.
How can you help?

Please check one or more boxes and we will send you more information.
Support *

Amazon Smile Donations Become part of the school board to influence school direction and policy Help out at school events Help in organizing an event Help our teachers as a class assistant or librarian Employer matching donations Be part of a parent committee Become a teacher Other

COVID-19 Protection Plan

The Dutch School Silicon Valley follows all local, state and federal guidelines regarding COVID-19 protection and prevention. Please read our COVID-19 protection plan and agree to follow the rules and regulations. By signing you acknowledge that you have read the plan and will follow the rules and regulations in it.
Dutch School Silicon Valley COVID-19 Protection Plan.pdf (LINK)
Signature

Clear

30 Day Cancellation Period
Enrollment for the school is for the duration of the entire school year.

The school takes on obligations for rent and teaching expenses based on the number of students in the classes. These costs can not be adjusted quickly. The school asks parents to give the school reasonable time to adjust its operations. The school uses a cancellation period of 30 days.

School tuition will be charged for the 30 days after the first day of the month follwing the submission date of the cancellation request, regardless if the student is able to attend class or not.

For parents that pay full year tuition, the balance is calculated and remaining credit will be refunded using the 30 day cancellation period.

HOW TO CANCEL

You can cancel enrollment by emailing the director and treasurer via director@dutchschoolsiliconvalley.org and penningmeester@dutchschoolsiliconvalley.org.

More information and these email addresses can also be found on our website: http://www.dutchschoolsiliconvalley.org

Tuition Payment Options

After registering the DSSV will try to place your student(s) in the best class.

Only when your student is placed in a class will the tuition and registration charges apply.

Tuition Contribution per student:

USD 1465 (USD 165/month) without employer reimbursement.
USD 2160 (USD 240/month) when you receive employer reimbursement.
Third child discount: 40% on the tuition for the third child.
School materials and books contribution: USD 50 / year

Regstration Fee per Family:

There is a yearly non-refundable registration fee of USD 100 (per family). The DSSV waives the registration fee when paying the yearly tuition in full before the beginning of the school year.
Additionally registration fee is reduced depending on when you finalize your registration. The discounts are shown in the table below:

Registration date before:	Discount on Registration Fee:
1st of May 2022	75%
1st of June 2022	50%
1st of July 2022	25%

Contribution Type *

My employer reimburses the school tuition (USD 2160 per student) We pay the school tuition ourselves (USD 1465 per student).
Payment preferences

Tuition contributions are done via ACH. The tuition is automatically transferred from your bank account to the bank account of the school. We have the ability to accept Credit Card for select situations.

The tuition can be contributed as a full year amount or in 9 monthly payments. When you contribute the full year tuition before the start lessons, the school will waive the registration fee for the year.

I choose to contribute the tuition in 1 full year payment or 9 monthly payments:
Tuition Payments *

1x Yearly 9x Monthly
Payment Methods

The School has a prefence to use direct bank to bank transfers (ACH) to reduce transfer costs and required volunteer time. You would quickly pay USD 45 per student per year to the payment provider to use a credit card. With using ACH you would save that money and perhaps use it for something more usefull.
Payment Preference *

ACH (automatic debit from bank account) Credit Card (+3.1%).
Date

Month Day Year
Date
NumStudents
PaymentBooks
RegistrationFee
PaymentReg
AchOn

Credit Card

Registration & Book Contribution

USD Description

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Waive and release
The undersigned (the “Signer”), being the parent(s) and/or legal guardian(s) of the minor child(ren) (the “student”) named at the beginning of this form, for valuable and sufficient consideration, receipt of which is hereby acknowledged, on behalf of themselves and the Child do hereby knowingly and intentionally fully and irrevocably release, to the full extent permitted by California law, the Dutch School Silicon Valley (the “School”), and its board members, directors, officers, sponsors, administrators, staff (e.g. teachers and teaching assistants), employees, volunteers and agents, from any and all claims or liability, known or unknown, of any kind whatsoever, which may now exist, or at any time in the future arise, with regard to any matters relating, directly or indirectly, to the student's enrollment or attendance at the School, or to the Signer’s or the student's participation in any activities directly or indirectly related to, or sponsored or sanctioned by, the School, regardless of whether or not said activities occur on School premises or elsewhere. By our initials below and by our signatures at the end of this form, we knowingly waive and release any and all legal claims that we or the child(ren) may now or in the future have against the School, or anyone connected with it.

At all times the school staff is authorized to take any measures necessary for the protection of my child(ren).
Initials *
We truthfully filled out this registration and understand what to do next.

To the best of our knowledge, all the information filled in on this registration form is true and complete. We have read the requirements and are fully committed to complying with them. We understand that payment of the required fees must be made by the payment deadlines outlined. Our signatures below affirm all of the above.
We authorize the school to open an account for the student with the Openbare Bibliotheek Amsterdam an provide access to Dutch language ebooks and other resources.
The students enrolling via this registration have received all immunizations required by the CDC for school and child care entry.
Signature of parent (or legal guardian) *
Signature of additional parent (or additional legal guardian) *
Should be Empty:

2022-2023 DSSV registration form

Contact information

Student Information

Student Information

Student Information

Authorization (in case of emergency)

For parents by parents: supporting, volunteering and donations

Permission to use Photographs

COVID-19 Protection Plan

30 Day Cancellation Period

Tuition Payment Options

Waive and release

We truthfully filled out this registration and understand what to do next.