The City School_new student welcome form

WELCOME FORM

The information provided here will remain confidential and is for school use only.
CHILD INFORMATION
Child's Name

First NameMiddle NameLast Name
Nickname
Year Level
Home Address
EMERGENCY CONTACT

(in the event of not being able to contact either parent)
Name

First Name & Last NameRelationship
Phone Number

Country CodePhone Number
Child's Doctor
Hospital

VACCINATIONS

Has your child been vaccinated against the following?

If you are unsure about the vaccine name, please contact our nurse at nurses@elc.ac.th
Vaccines Recommended by the Thai Ministry of Health:
DTnP-IPV-Hib
(Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b)
Vaccination Date

DayMonthYear
ROT-1
(Rotavirus)
Vaccination Date

DayMonthYear
Measles-Mumps-Rubela
Vaccination Date

DayMonthYear
TDAP-IPV
(Tetanus, diphtheria, pertussis, Polio)
Vaccination Date

DayMonthYear
Hepatitis B
Vaccination Date

DayMonthYear
Tdap
(Tetanus, diphtheria, pertussis)
Vaccination Date

DayMonthYear
Optional Vaccines:
Influenza
Vaccination Date

DayMonthYear
PNEU-C-13
(Pneumococcal Conjugate 13)
Vaccination Date

DayMonthYear
Meningococcal Conjugate C
Vaccination Date

DayMonthYear
Varicella
Vaccination Date

DayMonthYear
MEN-C-ACYW
(Meningococcal Conjugate ACYW-135)
Vaccination Date

DayMonthYear
HPV-4
(Human Papillomavirus)
Vaccination Date

DayMonthYear
Td booster
(Tetanus, diphtheria)
Vaccination Date

DayMonthYear
PNEU-P-23
(Pneumococcal Polysaccharide 23)
Vaccination Date

DayMonthYear
VITAL INFORMATION

Please check if your child has had any of the following:

Rows	YES	NO	Specific Details
Allergies to Food, Medication, Environmental Factors, or Bee/Wasp Stings
Asthma
Chronic Illness
Epilepsy
Febrile Seizure / Convulsion
Developmental Problems, Challenges or Disabilities
G6PD Deficiency
Hearing Problems
Surgery
Thalassemia
Vision Problems
Further details concerning any of the above

Please check if your child has had any of the following:

Rows	YES	NO	Specific Details
My child takes regular medication
My child requires emergency medication to be kept at school

PAST MEDICAL HISTORY

Please check if your child has ever had any condition(s) of the following:

Rows	YES	NO	Specific Details
Allergic Rhinitis
Anemia
Chicken Pox
Congenital Anomalies
Ear Infections
Heart Condition
Hepatitis
Kidney / Urinary Infections
Nose Bleeds
Tuberculosis
Typhoid
Others

PERMISSION
Y3 GROUP INSTRUMENTAL MUSIC LESSONS AGREEMENT
Children in Year 3 are given the opportunity to begin learning an instrument in school alongside their classroom music lessons. The lessons will be given in small groups, will be 30 minutes long, and delivered by musicians who are specialist in the instruments they teach. What instruments are offered? The instruments we can offer are Violin, Cello, Guitar, Flute, Clarinet and Recorder. Children will be given a demonstration lesson in the first week of term and then be asked which they may be interested to learn. We will then try to allocate a favoured instrument as best as we are able with the stock we have. Children study one instrument for the whole school year. How much does it cost? There is no extra cost for these group lessons as they are included in the school fees for one year. They are offered to give all Y3 ELC children an opportunity to learn a musical instrument as part of their education. (Note that should you wish them to take individual lessons on top of these lessons outside of school hours this is available at an additional cost). Do we need to buy an instrument? The school has a stock of instruments that will be loaned to children for the duration of Y3. Parents are only responsible for the cost of any damages to or loss of the instrument. How can I help my child do well on the instrument they choose? The best approach is very similar to improving reading, little and often. Even 5/10 minutes a day will aid improvement. We encourage children to make the most of the opportunity offered by doing some work at home. How does this affect other music in school? These lessons are being offered to enhance the musical opportunities for children at ELC. All children will continue to attend their twice-weekly singing, Orff ensemble and appreciating music classes.
CHILD CUSTODY AGREEMENT
Please inform us if there are the custody agreements in place for your family.
ADDITIONAL SPORT LESSONS
I give permission for my child to attend Physical Education classes off campus.
ELC PE SPORTWEAR
Would you like to order ELC PE Sportswear?
prevnext( X )
ELC PE Shirt
Enter description

200.00 THB Quantity

ELC PE Short
200.00 THB Quantity

Total

0.00 THB
Signature
Date

DayMonthYear
Parent's email

FOR NEW STUDENTS:
PERMISSION TO USE PHOTOS/IMAGE/ARTWORK

The ELC International School records various school activities as part of developing promotional materials and for our website. These may include the use of your child’s photograph and/or image, as well as artwork or other materials created by your child and/or the recording and/or transcription of dialogue spoken by your child. Your child’s first name only might be used when including dialogue from project work.

We would like to request your permission to use your child's image and work as mentioned above. Should you have any questions, please do not hesitate to contact us.
EXTENDED HOURS (K1)
Would you like to inquire for extended hours (1 - 2:30 PM)?
SHORT FIELDTRIP
I give permission for my child to participate in day field trips. I agree to him/her travelling by foot or vehicle such as a van or bus under the supervision of ELC staff members. I accept that ELC will provide due care and diligence and therefore will not be held responsible for any accident or injury that occurs during any field trip.
BUS SERVICE
Would you like to inquire for the bus service?
PRIVACY POLICY
Signature
Date

DayMonthYear

Click the submit button to record details.
Should be Empty:

WELCOME FORM

PERMISSION

Y3 GROUP INSTRUMENTAL MUSIC LESSONS AGREEMENT

ADDITIONAL SPORT LESSONS

ELC PE SPORTWEAR

FOR NEW STUDENTS:

EXTENDED HOURS (K1)

SHORT FIELDTRIP

BUS SERVICE

PRIVACY POLICY