Fairview Schools Penang Sdn Bhd (530740-V)

STUDENT APPLICATION FORM AND CONTRACT - Penang

Kindly submit the following with the Application form:

1. Two passport-sized photographs of the student

2. Student's Birth certificate and passport details
3. Student's Entry Visa / Malaysian Permit*
4. Father's and mother's Passport / IC Details
5. Father's and mother's Entry Visa
6. Three-year past school results in English
7. School Leaving Certificate and Testimonial from previous School(s) (translated to English)
8. Application Fee of RM 1000.00
9. Guardian Authorisation Letter (if applicable)

I/ We the parents/ guardian of the child hereby request that you enroll our child in your school and we agree that the information provided by me/us below shall form part of the contract between us and you and I/we confirm that the details provided are true.
SECTION A: STUDENT'S PARTICULARS
Surname/ Family Name:
First Name:
Date of birth:
Place of Birth:
Age:
Gender:
Local Address:

 

 
Telephone:
Mobile:
Permanent Address:

Telephone:
Mobile:
Religion:
Languages spoken at Home:
Other Languages:
Nationality:
Race: Malay/Chinese/Indian/Other
Passport/Birth certificate/ IC No (Malaysians only):
Passport Expiry Date
Visa Expiry Date
SECTION B: PARENTS' / GUARDIAN'S DETAILS
Father
Title:
Surname/ Family Name:
First Name:
Nationality:
Passport / IC (Malaysians only):
Mobile:
Telephone (O):
Email:
Company:
Designation / Occupation:
Company Address:

Mother
Title:
Surname/ Family Name:
First Name:
Nationality:
Passport / IC (Malaysians only):
Mobile:
Telephone (O):
Telephone (H):
Email:
Company:
Designation / Occupation:
Company Address:

Parents' Marital Status:
Guardian (Other than parents, if applicable)
Surname/ Family Name:
First Name:
Nationality:
Passport / IC (Malaysians only):
Mobile:
Telephone (O):
Email:
Company:
Designation / Occupation:
House Address:

Relation to the applicant:
SIBLINGS
Name Date of Birth Current School's Name
EMERGENCY CONTACTS (Other than parents & guardian) :
Surname/ Family Name:
First Name:
Mobile No:
Telephone:
Email:
Relationship to the applicant:
SECTION C: STUDENT'S EDUCATION BACKGROUND
ACADEMIC
PREVIOUS SCHOOLS (Begin with the most recent) Joining Date Leaving Date Grade / Level Reason for leaving
Has the student ever been offered double promotion? :
If yes, please give details:
Please list the co-curricular activities that the student has participated in at School level:
Sports Clubs

SECTION D: STUDENT'S HEALTH RECORD

Diet

Does the student have any of the following medical conditions?
a. Asthma g. Blood disorder
b. Epilepsy h. ADHD
c. Fits due to high fever i. Psychological disorder
d. Kidney disease j. Dyslexia
e. Heart problem k. Learning Difficulties
f. Diabetes mellitus l. Others
Is the student taking any prescribed medication regularly?

If yes, please specify medication:

Is there any physical or audio / visual impairment?

If yes, please give details:

Please specify if the student has had the following infections and/or vaccination.

Infectious Disease

Vaccination
a. Measles a. Tetanus
b. Chicken pox b. Polio
c. Mumps c. Diphtheria
d. Others (Please state) : d. BCG
e. Cholera

Please state any drugs / foods / drinks allergy, if any:

Please state briefly any other useful information that the class teacher / Principal should know about the student.
SECTION E: BILLING DETAILS
Bill to:
PAYMENT DETAILS (to be completed if payment is not made by parents or guardians)
Individuals:
Name: (Please underline your surname.)
Mobile:
Telephone (O):
Email:
Address:

Relationship to the applicant:
Company:
Company's Name:
Person In Charge's Name:
Telephone (O):
Fax:
Email:
Address:

SECTION F: AGENT DETAILS
If an applicant is being introduced by an approved agent, please complete the following:
Name of agency:
Contact Name:
Telephone : Business
Email:
Fax:
Address:

SECTION G: CONTRACT TERMS AND CONDITIONS OF ENROLMENT

I/We hereby agree to the above terms and conditions