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British Columbia Canadian International School
BCCIS WEST - Application Form
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*
" indicates required fields
A- Student Information
Name:
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First
Middle
Last
Grade Applying to:
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Gender:
*
DOB:
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MM slash DD slash YYYY
Passport No.:
*
Nationality:
*
Religion:
*
Country of Birth:
*
Language at home:
B- Current School /Nursery Attended
Name:
Curriculum:
Grade:
C- Previous Schools Attended (Ordered by most recent)
Previous School Name:
Date Entered:
Date Left:
Curriculum:
Previous School Name:
Date Entered:
Date Left:
Curriculum:
If the student ever repeated a grade, which grade? If the student ever skipped a grade, which grade?
D- Transportation
Will the student require bus transportation?
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Yes
No
Home address:
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Home Location:
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E- Parent / Guardian Information
Relationship to Student:
Parent First Guardian
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Parent Second Guardian
Full Name:
Parent First Guardian Full Name
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Parent Second Guardian Full Name
Home Telephone No.
First Guardian Home Telephone No.
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Second Guardian Home Telephone No.
Mobile Phone No.
First Guardian Mobile Phone No.
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Second Guardian Mobile Phone No.
E-mail
Parent Email
*
Nationality
Parent First Guardian Nationality
Parent Second Guardian Nationality
Address
First Guardian Address
Second Guardian Address
Occupation
First Guardian Occupation
Second Guardian Occupation
Organization
First Guardian Organization
Second Guardian Organization
F- Custody:
Custody Parents are:
Custody:
G- Siblings
Siblings Name:
Siblings Age:
Siblings Current School / Nursery:
Siblings Current Grade:
H- Emergency Contact (other than guardians)
Emergency Contact Name:
Emergency Contact Phone No.:
Relationship to Student:
I- Medical information
Blood type:
Surgical History:
Current Medication:
Allergies:
Chronic Diseases:
Special conditions:
Other conditions: social, behavioral, and/or emotional
J- Additional information
Additional information:
Agree to Terms and Conditions
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I certify that all of the information provided are true, complete, and accurate and authorize BCCIS to request additional information from teachers/counselors/expert professionals for verification. Acceptance of the child is dependent upon successful fulfillment of our admission requirements. By accepting an application, the school does not guarantee student admission. I hereby give permission to the school clinic to administer all necessary checkups, first aid non- prescriptive medications and to act in casualties and emergencies including admittance to hospital in case of emergency.
I agree to the terms and conditions.
Name
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