DSSV Registration Form 2024

2024-2025 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 the moment they are 2.5 years old.
- Tuition Contribution Preschool per student per year, ages 2.5-4 (home program with one monthly in class):
  - USD 495
- Tuition Contribution per student per year, ages 5-18 (weekly in class, in-person and hybrid):
  - USD 1575 (USD 175/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 (not applicable for Preschool program).
  - School materials and books contribution: USD 50 / year
  - Tuition fee will be applied pro rata when registering during the school year.
- Registration fee: USD 100 per family
- Private Classes fee: USD 80 / hours

Contact information

We would like to register one or more students (per family) for the 2023-2024 school year at the Dutch School Silicon Valley.
Contact Name*

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

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

Emergency First NameEmergency 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: Volunteer Positions

DSSV is a 501 (c) (3) nonprofit organization. As such, our school also depends on donations from our families 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. All in-class volunteer positions are on a rotating schedule.
How can you help?

Please check one or more boxes and we will send you more information.
I'm interested in the following volunteer position:*

Class ParentIn-class assistant to teachers teamIn-class library/reading assistant (approx. 30 minutes per class)Member of the DSSV Library CommitteeMember of the DSSV BoardAssisting at one or more cultural events (Children's Book Event, Sinterklaas, Ice Skating, King's Day)Website maintenanceMaintenance storage facility (Palo Alto)

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

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 and provide access to Dutch language e-books 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:

Registration date before:	Discount on Registration Fee:
15th of June 2024	75%
1st of July 2024	50%
15th of July 2024	25%

2024-2025 DSSV registration form

Contact information

Student Information

Student Information

Student Information

Authorization (in case of emergency)

For Parents By Parents: Volunteer Positions

Permission to use Photographs

30-Day Cancellation Period

Tuition Payment Options

Waive and release

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