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*Proposed commencement date: |
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*Grade: |
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*Campus: |
Lakeside Campus Tanjong Katong Campus
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*Pre-Kindergarten Chinese Immersion (Half day), Pre-Kindergarten Chinese/English Immersion (Full day) and Grade 6 Bilingual are currently not available at Tanjong Katong Campus |
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*French English Bilingual Programme is currently not available at Tanjong Katong Campus |
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*Last name (as in passport): |
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*First name (as in passport): |
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Middle name/s (as in passport): |
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Preferred name (if applicable): |
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*Date of birth: |
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*Gender: |
Female Male
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*Country of birth: |
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*Nationality: |
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*Passport number: |
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*Passport country: |
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*Passport expiry date: |
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*Dual citizenship: |
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*Specify dual citizenship: |
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*Ethnic group: |
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*Student's Singapore residency status: |
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*With whom will the student reside in Singapore? |
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*Others - please specify: |
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*Are there any family circumstances we need to be aware of i.e. divorce, separation, legal/custody and living arrangements? |
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*If yes, please provide details: |
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*Siblings currently attending CIS: |
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Sibling #1: |
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Sibling #2: |
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Sibling #3: |
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*Siblings applying to attend CIS: |
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Sibling #1: |
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Sibling #2: |
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Sibling #3: |
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*Last name (as in passport): |
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*First name (as in passport): |
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Singapore home address: (all
correspondence will be sent to this address) |
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Overseas home address: |
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*Nationality: |
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*Singapore residency status: |
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Telephone number (Overseas): |
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Telephone number (Singapore): |
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Mobile number (Overseas): |
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Mobile number (Singapore): |
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*Email: (will be used for school communications) |
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*Occupation: |
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*Company name: |
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*Industry: |
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Telephone number (Office): |
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*Last name (as in passport): |
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*First name (as in passport): |
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Please tick the following box if Singapore home address is same as spouse |
Singapore home address: (all
correspondence will be sent to this address) |
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Please tick the following box if Overseas home address is same as spouse |
Overseas home address: |
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*Nationality: |
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*Singapore residency status: |
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Telephone number (Overseas): |
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Telephone number (Singapore): |
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Mobile number (Overseas): |
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Mobile number (Singapore): |
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*Email: (will be used for school communications) |
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*Occupation: |
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*Company name: |
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*Industry: |
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Telephone number (Office): |
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*School communications should be sent to: |
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*Others - please specify: |
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In case of emergency the school should contact: |
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*Name: |
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*Relationship to student: |
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Emergency home phone: |
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Emergency office phone: |
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*Emergency mobile phone: |
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Email: | *
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Company to be billed: |
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*Attention to: |
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Please tick the following box if the Billing Address is the same as the Residential Address
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*Billing address for all fees: |
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Phone: |
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Email: |
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Fax: |
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*How long have you resided in Singapore? |
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*How did you find out about CIS? |
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*Other - please specify |
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*How many years has your child been in an educational setting? |
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*What grade is your child currently in? |
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Current school |
Previous school 1 |
Previous school 2 |
Previous school 3 |
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*School name: |
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*School country: |
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*Start date: |
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*End date: |
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*Highest grade completed: |
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*Language of instruction: |
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Contact details for most recent school attended |
School name: |
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Contact person: |
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Position: |
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Email: |
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Telephone number: |
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*Why is your child leaving his/her current educational setting? |
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*HEALTH AND SAFETY |
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*Does your child have any medical conditions, which may influence his/her participation in classroom or in sports? |
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*Please state the nature of the condition(s) and submit all medical reports: |
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*Does your child have any allergies, which may influence his/her participation in classroom or in sports? |
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*Please state the nature of the allergies: |
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*Does your child require any medication? |
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*Please list the details of the medication: |
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*ACADEMICS |
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*Has your child ever been assessed with learning difficulties? |
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*Nature of the difficulty: |
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*Has your child ever benefited from academic/ learning support? |
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*Nature of support or remedial help: |
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*Has your child ever been assessed as gifted/talented? |
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*If yes, please provide details: |
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*Has your child ever been supported by a specialist (i.e. psychologist, speech pathologist, counsellor, occupational therapist)? |
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*If yes, please provide details: |
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*Has your child have any hearing, speech or physical difficulty? |
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*If yes, please provide details: |
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*Does your child have any social, emotional or behavioural difficulty? |
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*If yes, please provide details: |
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*Other academic concerns? |
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*If yes, please provide details: |
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Please include any other comments or information which will enable our teachers to understand your child better: |
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*LANGUAGE |
*What is your child's first/native language? |
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What is your child's second language? |
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In which other language is your child proficient? |
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*What is your child's English proficiency? |
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If your child's first / native language is not English, how long has your child been learning English? |
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*Which language is spoken at home (if more than one, please list)? |
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*Has your child ever studied a language other than English at school? |
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*Does your child receive additional support with his/her first language? |
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*If yes to any of the above, please provide details: |
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*Please list previous countries of residence: |
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*Please list all languages studied including mother tongue: |
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*Where (country)? |
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*How long? |
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*Type of programme (For example - First language instruction/ second language class/ immersion programme/ bilingual programme, etc)?
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Additional comments: |
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*Mode of payment: |
Cash Cheque Telegraphic Transfer (TT)
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Acknowledgement, Acceptance and Indemnification
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I, the undersigned Applicant (“Applicant”), request the enrolment of my Child. I certify that all particulars furnished in this application and any accompanying documentation are true, accurate, complete, original and authentic. I further understand that I will be required to read, understand and sign a copy of the Student Contract upon acceptance. I will also be given an e-copy of the Parent Handbook, which will provide me with further information about the School.
Without prejudice to the generality of the foregoing, by my submission of this application, I warrant that I am the Parent or Legal Guardian of the Student and that I am able to act on behalf of both Parents (if a parent is the Applicant) and all Legal Guardians (if a Legal Guardian is the Applicant) of the Student; and hereby indemnify the School in respect of any breach of any of the above representations. The School shall be entitled to rely upon such representations without further enquiry and the foregoing indemnity shall not be affected by any notice, actual or constructive of the School, to the contrary. The School shall be entitled at any time and from time to time, to require me to provide any information (or documentary proof) relating to myself, my hild/Ward, my child’s Parents or Legal Guardians and the School shall not be obliged to verify any information, matter or instruction provided by me or my nominated Contact Person, whether a Representative (nominated by a Representative Form) or Caregiver (nominated by a Caregiver Form). By my completion of the Representative Form or the Caregiver Form, I am deemed to have authorized the School to communicate solely with the Representative or Caregiver and have agreed to indemnify the School against any liability, claim, demand, suit by or settlement with, any Parent or Legal Guardian of the child in respect of any action or omission taken by the School on the instructions of the Representative or Caregiver.
The School reserves the right to request private assessments such as psycho educational and/or occupational therapy, ADHD identification and visual or auditory assessments, as well as the right to request additional Learning Support services for a student, if such a programme is required to ensure success at the School. All placement decisions are made by the School.
Personal Data Protection Act
In submitting my personal data to you and signing this form, I acknowledge and consent to your collection, use, process or disclosure of my/my child’s/my ward’s personal data for the purposes reasonably required in connection with your provision of services, including but not limited to those purposes specified in your Personal Data Protection Policy*, the terms of which are hereby incorporated by reference.
I also consent to the disclosure of my /my child’s/my ward’s personal data to your third party service providers, agents, affiliated companies and/or other third parties, whether within or outside Singapore, for one or more of the above mentioned purposes.
* A copy of our Personal Data Protection Policy can be found on our website or by request. If you have any questions relating to our Policy or would like to withdraw your consent to use of your data, please contact our Data Protection Officer at pdpa@cis.edu.sg.
Accuracy of Information
I warrant that all information submitted in this form, including my/my child’s/ward’s personal data, is true and accurate and undertake to notify the school promptly of any changes.
Where I have provided personal data relating to other individuals (including minors), I represent and warrant that I am authorised to provide their personal data to you and have obtained their consent to the collection, use, processing and disclosure of their personal data in accordance with the purposes reasonably required in connection with your provision of services.
*Applicant - father's/mother's/legal guardian's full name:
To be able to select the "Submit" button, you must select the above checkbox to confirm your acceptance of the Terms & Agreement.
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