Student Enrollment & Release Form: SPROUTS

ENROLLMENT APPLICATION FORM

Please fill out this form, one for each student for whom you are applying. This form is to be completed by a parent or guardian
THANK YOU FOR COMPLETING, PRINTING LEGIBLY OR TYPING
Student's Photo

Passport size
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PRIMARY CONTACT INFORMATION
Enrollment*
School Year
Class name
Student Name*

First NameLast Name
Birth Date*

DayMonthYear
Gender*
Nationality*
Language spoken at home*
Home Address
Has attended before any Kindergarten/Preschool ?
LANGUAGE BACKGROUND
Native Language*
Other language
Other language
PARENT INFORMATION
MOTHER

First NameLast Name
Nationality
Phone number
E-mail:
Work address:
FATHER

First NameLast Name
Nationality
Phone number
E-mail:
Work address:

MEDICAL BACKGROUND
1. Does your child, to your knowledge, have any particular learning disabilities?
if yes, please specify
2. Does your child take any medication?
if yes, please specify
3. Does your child have any of the following: Asthma, convulsions, diabetes, kidney disease, heart trouble, heart disease, blood disorders, known vision and hearing loss, known allergies, behaviour problems?
if yes, please specify
4. Has your child had any surgeries, serious accidents?
if yes, please specify
5. Please check any of the following childhood illness your child has had:

BronchiolitisHand, Food and Mouth Disease (HFMD)Chicken Pox (Varicela)Rubella (Rubeola)Measles (Rujeola)Mumps (Oreion)
6. Name of your child’s doctor and/or clinic:
EMERGENCY CONTACTS

(Please provide two additional people, different from the parent/guardian listed above, who would automatically be the first person we contact).
1. Name/Surname*

First NameLast Name
Relationship*
Phone number*
2. Name/Surname

First NameLast Name
Relationship
Phone number

PARENT HANDBOOK
PLEASE CLICK HERE TO DOWNLOAD CHIPS PARENT HANDBOOK.
I have downloaded CHIPS Parent Handbook. I have reviewed and accept all policies stated within the document.

I ACCEPT
TUITION POLICY
PLEASE CLICK HERE TO DOWNLOAD CHIPS TUITION FEES AND POLICY.
I understand that tuition is an annual fee and can either be paid one of two ways, 1) in full or 2) in two halves. I will meet my tuition obligations by using the payment plan I have chosen.
I understand tuition is an annual fee and can either be paid one of two ways, 1) in full or 2) in two halves. I choose to meet my tuition obligations by using the payment plan I have chosen.

PHOTO PERMISSION

Students at CHIPS will be involved in school activities where they may be photographed. The majority of parents are happy for their child’s photograph to be used and their children enjoy seeing their photographs in the school publications and social media platform. Photographs of students may be used in a variety of media to celebrate a student’s success in a particular area or for educational purposes or to promote activities at the school. Photographs of children are also used in newspapers, school brochures, web site and social media platform Facebook. We need parental permission to publish children’s photographs. Your child’s name will not be linked to the photos. No child’s photograph will knowingly be published without parent permission.
Please note that this permission agreement is valid only for the duration of your child’s schooling at CHIPS.

I, do give permissionI, do NOT give permission
FIELD TRIP PERMISSION

During the school year, students are taken on field trips. Some of these are in the local area and others are outside the community. When the students go on trips outside the community, they are transported by buses hired by the school.Parents will be notified in advance by their child’s teacher of the specific field trips to be taken.
I, do give permission to my child to attend all field trips organised by the school during the yearI, do NOT give permission to my child to attend all field trips organised by the school during the year
PARENTHAL AUTHORITY

The student can be picked up by the people authorized in this form. Please list all individuals who are authorized to pick up your child/children. The individuals will also be called in the event of an emergency if the parents cannot be reached.
I, authorize the following people to pick up my child from CHIPS:
name/surname, relationship and phone number
I, do NOT authorize the following people to pick up my child from CHIPS:
name/surname, relationship and phone number
PTA APPLICATION

Use your PTA Membership to: Get Connected. PTA provides opportunities to meet and network with other parents, teachers, and school administrators. There is no better way to know what’s happening in your child’s school and CHIPS community! Speak Up. By becoming part of PTA, you will be part of the solution, to help make positive changes in your child’s school and in the lives of many children. Effectively Engage. Spend quality time with your children through PTA programs and events. Not only will you show how much you care about them, but you will also demonstrate the importance you place on their education. Watch Yourself Grow. If you decide to be a volunteer, you can use your skills and hobbies for a relevant cause while setting a good example for your child and all children in the CHIPS community. How Does Joining the PTA help our school? These are just a few examples of the items your contributions help to fund: - Help small groups of students in daily activity program;- Manage a classroom project (in class or organising at home) or outside garden areas;- Assist a field trip or safety training supervised by Regional Security Office of the US Embassy;- Organise or participate in a special calendar event;- Organise and participate in charity programs
I, do APPLY for PTAI, do NOT APPLY for PTA

PROGRAM DETAILS
CHIPS is committed to inquiry-based learning and international mindedness. Through a thoughtful and stimulating environment, structured play, song, art, and movement, children develop language, social, emotional, and cognitive skills that lay the foundation for their long-term personal and academic success.

CHIPS welcomes children between the ages of three and six to learn in English.

English is the language of instruction at CHIPS. The teaching team has native English, Romanian, and Russian-speaking teachers, thus easing the transition of non-fluent children into the English language environment.

*We ask all families to place a non-refundable enrollment fee deposit equal to 200 EURO. This non-refundable registration fee is required to reserve a place in class.
Which PROGRAM will your child attend at CHIPS:

Full Day: Monday - Friday / 08:00 - 18:00 /Main Program + AfterschoolHalf Day: Monday - Friday / 08:00 - 15:00 /Main Program
We do not pro-rate any portion of the tuition fee and do not offer refunds due to missed classes, illness, vacation, school holiday, or personal schedule conflicts.

I ACCEPT
Withdrawal from the school is permitted up to 10 days before the start of the term with a 75%refund. After that, no refunds will be processed. All requests for cancellation and refunds must be submitted in writing and emailed to info@chips.md.

I ACCEPT

I certify that I have completed the Health History and Health Questionnaire is fully accurate and accept full responsibility for any errors or omissions.

I ACCEPT
PLEASE CLICK HERE TO DOWNLOAD CHIPS HEALTH POLICY.
MEDICAL/DIETARY QUESTIONS
Food Requests: Please indicate any dietary requests due to your child’s preferences, religious practice, lactose intolerance, food sensitivity, or treatment for a behavioural condition. The following requests are NOT due to a food allergy:
Miscellaneous: Is there anything else that you believe it is important we know in regards to your child’s participation in this program? If so, please describe:
DECLARATION
I, parent/ guardian of student's name/surname hereby declare that all the information provided in the application form is true and correct and has been offered freely. Furthermore, I hereby authorize the transfer of this information to the school’s electronic database.
First NameLast Name
Date

DayMonthYear
Date
Signature

Clear
Should be Empty:

ENROLLMENT APPLICATION FORM

PRIMARY CONTACT INFORMATION

LANGUAGE BACKGROUND

PARENT INFORMATION

MEDICAL BACKGROUND

EMERGENCY CONTACTS

PARENT HANDBOOK

TUITION POLICY

PHOTO PERMISSION

FIELD TRIP PERMISSION

PARENTHAL AUTHORITY

PTA APPLICATION

PROGRAM DETAILS

DECLARATION