Please email your child’s recent photo as a JPEG image file to festivalnaya@atlanticschool.ru
or attach a photo here. (Do not staple or glue)
Registrar’s Office
115088, Moscow, Sharikopodshipnikovskaya Street, 30A Block 1 www.atlanticschool.ru | Tel.: +7(495) 661-8691 | Fax: +7(495) 661-8692 Applications for Atlantic International School must be returned to the AIS Registrar of the applied school. Please type or print in black ink.
Application for Admission Personal Data (Student)
01 Family Name
02 First Name
03 Middle Name
04 Mother’s full name
05 Father’s full name
06 Birth date
07 Place of birth (City/Country)
08 Citizenship(s)
09 Gender
10 Campus Applied for AIS Dubrovka AIS Skolkovo
■ Male
Female
11 Expected enrollment date (DD/MM/YY) AIS Festivalnaya AIS St.Petersburg
01/01/2011
12 Student resides with (check all that apply)
Mother
Father
Stepmother
Stepfather
Other legal guardian
13 Name and telephone number of Translator (required if parents are not fluent in English or Russian)
14 Name of Sibling(s) Age Current School
15 Does your child have any medical concerns that the school should know about? If so, please provide details.
Yes
No
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Application for Admission 16 Language most of the time spoken by child at home
17 Other Languages (indicate whether fluent,intermediate, or basic) Language
Speaking
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Reading
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Writing
select...
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18 Previous Education list all schools starting with most recent (please include pre-school) Name Of School
Country
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Grade
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Month/year
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Family: 19 Home Address in Moscow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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20 Home Telephone Number in Moscow
21 Home Telephone Number (Native country)
22 Home Address (Native country) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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23 How did you first learn about AIS?
Internet
Company
Consulate
Friend
AIS parent
Other
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115088, Moscow, Sharikopodshipnikovskaya Street, 30A Block 1 www.atlanticschool.ru | Tel.: +7(495) 661-8691 | Fax: +7(495) 661-8692
Application for Admission Personal Data (Family) Father 24 Last Name
25 First Name
26 Middle Name
27 Nationality
28 Languages spoken by Father
29 Employer
30 Position in company
31 Business Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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32 Business Telephone
33 Business Fax
34 Mobile telephone
35 E-mail
Mother 36 Last Name
37 First Name
38 Middle Name
39 Nationality
40 Languages spoken by Mother
41 Employer
42 Position in company
43 Business Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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44 Business Telephone
45 Business Fax
46 Mobile telephone
47 E-mail
115088, Moscow, Sharikopodshipnikovskaya Street, 30A Block 1 www.atlanticschool.ru | Tel.: +7(495) 661-8691 | Fax: +7(495) 661-8692
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Application for Admission statements Physical Education
48 In order to ensure a safe and active environment in classes it is important to provide information regardind your child’s health condition. A. Please list any physical concerns (allergies, asthma) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. Please list any medication which may affect performance in physical activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
My child may participate in all physical activities
I agree
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I disagree
My child may attend swimming classes ■
I agree
I disagree
Parent or Guardian’s signature
Date: . . . /
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Bus Service
49 I intend to have my child use the school bus. It is my wish that my child ride the school bus to and from AIS.
I agree
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I disagree
Parent or Guardian’s signature
Date: . . . /
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Photo Release
50 Occasionally photos are taken of children in class or engaged in school activities. These photos are sometimes used for school promotion (school newspaper, school website, brochures, and adversitements). I give my permission for my child’s photo to be used for these purposes.
I agree
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I disagree
Parent or Guardian’s signature
Date: . . . /
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Medical Release and Permission to treat
51 Should my child become acutely ill or injured while in attendance on the campus of AIS or on an AIS school trip the school nurse, first aid assistant, administrators and/or other members of the school staff have my permission to request medical assistance, emergency or otherwise. I understand that the staff members of the school will take all necessary precautions at their disposal to ensure the safety of my child while attending AIS. I take responsibility to inform the school of any changes in my child’s health.
I agree
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I disagree
Parent or Guardian’s signature
Date: . . . /
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Permission For Routine Health Screenings
52 I give my permission to perform routine check of my child’s vision hearing,weight,height done on a yearly basis or as required.
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I agree
I disagree
Parent or Guardian’s signature
Date: . . . /
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AIS Identification Cards
53 I kindly ask you to provide me with AIS identification cards for Name of the Guardian
Passport No
Automobile Lic. Plate No
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with the right to collect my child
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Parent or Guardian’s signature page
4
115088, Moscow, Sharikopodshipnikovskaya Street, 30A Block 1 www.atlanticschool.ru | Tel.: +7(495) 661-8691 | Fax: +7(495) 661-8692
(name
of the child)
Date: . . . /
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