http://www.iskonline.org/files/forms/Admission_Packet_2009-2010 by Kamila Nosek

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

Student’s name ___________________________________________

ISK ADMISSION CHECKLIST Please complete, sign and submit the following forms included in the admissions packet:

 APPLICATION FOR ADMISSION  PHOTOCOPY OF CHILD’S PASSPORT OR BIRTH CERTIFICATE  STUDENT MEDICAL FORM – to be completed before the first day of school; the examination is valid six months prior to admission

 REQUEST FOR TRANSCRIPTS  LANGUAGE INTEREST SURVEY  PHYSICAL EDUCATION QUESTIONNAIRE  CONTRACT

ADMINISTRATIVE USE ONLY ADMISSION # ______________

______ Accepted _______ Grade______ Waiting list _____ Grade______ Rejected ______ Grade Pending

 School records

 Health form

 Copy of resident permit/passport

 Test results  Other documentation

Administrator’s Name __________________ Date _______________ ISK Admission Packet - 1 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

APPLICATION FOR ADMISSION For the Academic Year _______ - _______ Expected entry date_________ Expected length of stay_________

PERSONAL DATA OF CHILD Student's family name ___________________________________ First name(s) __________________________________________ Date of birth

Day _________Month ________Year __________

Place of birth___________________________________________ Passport number________________________________________ PESEL number (if available) ______________________________ Citizenship ____________________________________________

(Please attach recent photograph here)

Original nationality______________________________________ Sex ________________ Current grade ______________________ Native language(s) ______________________________________ Other languages spoken __________________________________ ADDRESS Permanent address in Krakow area: Street ______________________________________ Postal code ______-___________ City _______________________________________ Tel. ________________________ Address for immediate correspondence (if different from permanent address): Street_______________________________________ Postal code ______-___________ City_________________________________________Tel.________________________ ISK Admission Packet - 2 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

PREVIOUS SCHOOLING

Name of school

Address

Dates attended

School records submitted

SIBLINGS Family Name

First name

Date of birth

Current school

Has your child ever been referred or tested by outside agencies (e.g. Child Guidance, Clinic, learning, speech, psychological assessments, etc.)? YES NO

 

(if yes, please attach documentation)

ISK Admission Packet - 3 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

PERSONAL DATA OF PARENTS/GUARDIANS (For School Directory and internal use only) Mother's family name _________________

Father's family name _________________

First name _________________

Nationality _________________

Occupation _________________

Employer's name _________________

Employer's address _________________

Street _________________

Postal code ________ City ___________

Tel ____________ Fax ____________

Mobile _________________

E-mail _________________

E-mail: _________________

EMERGENCY CONTACTS Please provide the names and telephone numbers of emergency contact persons if parents/guardians are not available.

Contacts (other than Parents/Guardians) Name________________________Tel. __________________Mobile________________________ Name________________________Tel. __________________Mobile________________________ Name________________________Tel. __________________Mobile________________________

ISK Admission Packet - 4 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

TUITION / FEES This tuition will be paid by __________________________________________________________

 Company (NIP: _________________)  Government

 Parents/Guardians

Contact person _________________ Tel _________________ Fax _________________ Street address ____________ Postal code _______ City _________Country _________________

The Registration Fee is to be submitted with the application for admission. The receipt of payment should be attached. No application is considered without the Registration Fee. This fee is charged only once to each new student entering ISK In order for your application to be considered and processed, the following documentation must be included with this application form:

 Previous school records

 Standardized test results

 Copy of residence permit/passport

 Registration Fee

PLEASE CHECK THE BOXES THAT APPLY

 I DO

 I DO NOT authorize the use of my child's photograph for school

publications and promotional materials.

 I DO

 I DO NOT give permission to publish our address/telephone number in the ISK Telephone Directory.

__________________________ Signature of Mother/Guardian

__________________________ Signature of Father/Guardian

______________________ Date

ISK Admission Packet - 5 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

REQUEST FOR TRANSCRIPTS Previous Educational Institution: School Name:

__________________________________

School Address:

__________________________________

City, Zip Code, Country:

__________________________________

Telephone Number:

__________________________________

Fax Number:

__________________________________

Contact Person/Title:

__________________________________

Student, ________________________ will be attending The International School of Krakow in academic year __________. We formally request a copy of all student records to be sent to the following address: The International School of Krakow Attn: Administrative Officer Lusina ul. św. Floriana 57, Krakow 30-698 Tel/Fax: +48 12 270 14 09

The timely receipt of these materials is vital to the continuity of continued education of the above named student. Thank you for your cooperation.

_________________________________ Parent/Guardian’s Signature Date

_____________________________ Administrator's Signature Date

ISK Admission Packet - 6 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

STUDENT MEDICAL FORM PART I

(may be completed by family)

Student’s name:

__________________

Grade: ___________ Sex:

Date of birth:

__________________

Nationality:

M F

_____________________

Parent/guardian name:__________________

Language spoken at home:

Home phone:

__________________

Work phone:

_____________________

Mobile phone: (Mother) E-mail address: (Mother)

_________________

Mobile phone: (Father) E-mail address: (Father)

_____________________

_________________

_______________

_____________________

IMMUNIZATION RECORD (Provide Dates- month, day, year)

PERTUSIS DIPHTHERIA TETANUS POLIO MEASLES MUMPS RUBELLA

TB TEST HEPATITIS

HEPATITIS

** BCG OTHER

* Hepatitis B is highly recommended in Poland ** If BCG done more than five years ago a TB test or chest x-ray is required

ISK Admission Packet - 7 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

MEDICAL HISTORY Allergies ________________________________________________________________________ Serious illness, injury or surgery in the past _____________________________________________ Childhood diseases (chicken pox, measles, mumps, others, please specify) ____________________ ________________________________________________________________________________ Chronic medical conditions _________________________________________________________ Current treatment _________________________________________________________________ Regular medication ________________________________________________________________ Does your child wear any of the following? (Please tick appropriate) Glasses 

Contact Lenses 

Hearing Aids 

Removable Dentures or Plates 

Braces (on teeth)  Other _________________________________________________________

May your child have Tylenol (Panadol, acetaminophen) cough drops or throat lozenges at the nurse’s discretion?

Yes 

No 

Medical Insurance ________________________________________________________________

If you are a member of a medical care facility, i.e. Medicover, etc., please provide company name and membership number ___________________________________________________________

_____________________________________ Parent/Guardian’s Signature Date ISK Admission Packet - 8 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

PHYSICAL EXAMINATION PART II (to be completed by certified medical professional)

Required: Height _______cm

Weight _______kg

Tuberculinum skin test

(or chest ray)

Blood pressure ______ Hgb/Hct ______Urine _______

Date _______________

Results __________________________

Mantoux____________

Tine ______________________

Date _______________

Results ____________________

VISION

HEARING

(using vision chart)

audiogram results

w/o glasses

R_________ L_________

with glasses

R_________ L_________

Hearing (can repeat softly spoken words)

_________________________________ EXAMINATION (mark √ for any problem and explain in the space provided) Eyes  __________________________________________________ Ears



__________________________________________________

Nose, throat



__________________________________________________

Oral cavity, teeth



__________________________________________________

Respiratory track



__________________________________________________

Heart, circulatory system



__________________________________________________

Genito-urinary



__________________________________________________

Neurological



__________________________________________________

Musculoskeletal



__________________________________________________

Spine (curvature or other)



__________________________________________________

Extremities



__________________________________________________

Feet (flat, torsion, etc.)



__________________________________________________

Gait walking, running



__________________________________________________

Abdoment



__________________________________________________

Skin (rashes, eczema, etc.)



__________________________________________________

Development for age



__________________________________________________

Nutritional status



__________________________________________________

Mental/behavioral status



__________________________________________________

Speech



__________________________________________________ ISK Admission Packet - 9 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

Overall appraisal of health, capabilities, limitations: ______________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Recommendations: I have examined the person herein described and have reviewed the health history, as recorded above. It is my opinion that this person physically able to engage in all school activities, except as noted above.

_________________________________________ Signature and Doctor’s Stamp Date _________________________________________ Print name _________________________________________ Address

ISK Admission Packet - 10 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

DIETARY INFORMATION SHEET Student’s name ______________________

Grade _____________

Date of Birth: ________Month ______Day _______Year Food Allergy (e.g. peanuts)

Indicator(s) of Reaction (e.g. hives, throat swelling)

Actions necessary to counter reaction (e.g. call ambulance, call parent)

Elective Dietary Restrictions:

(Please detail the food groups, which are restricted, providing as much detail as possible)

Restricted Food Group (e.g. meat)

Details (e.g. fish is okay)

_________________________________________ Parent/Guardian’s Signature

Date ISK Admission Packet - 11 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

LANGUAGE INTEREST SURVEY

Student’s name _____________________

Grade _____________

Foreign and native language offerings are determined based on interest, staffing capabilities and funding. In order to prepare for next year, we would like to know which language offerings interest you most.

Please rank in order of importance 1= Most important, 2= Second most important, 3= Third most important

NATIVE LANGUAGE

FOREIGN LANGUAGE

ENGLISH AS A SECOND LANGUAGE (ESL)

 Polish

 ESL

 French

 German

 Dutch *

 Spanish

*If separately enrolled in the Dutch School operating within ISK

Other: _________________ (please identify)

_________________________________________ Parent/Guardian’s Signature

Date

ISK Admission Packet - 12 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

APPROVED MODES OF TRANSPORT TO AND FROM SCHOOL

Student’s name ______________________

Grade _____________

(Check all that apply)



My child may choose to use public transportation/on foot



My child may choose to call a taxi for pick-up



My child may leave school with any other parent from the school

Parent(s)/Guardians named ________________________________may take my child from school.

If you choose another person or approved method of transport, please notify the school in a signed letter. We will assume that a child’s parents/guardians are authorized to pick them up, unless we are informed otherwise.

_________________________________________ Parent/Guardian’s Signature

Date

ISK Admission Packet - 13 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

PHYSICAL EDUCATION QESTIONNAIRE Student’s name ________________________

Grade _____________

To make sure your child can benefit from safe and active Physical Education classes, please provide specific information regarding your child’s health condition.

(Please tick appropriate)

 My child may participate I all physicall activities.  Performance in PE classes may be affected by the following: A. Physical problem (allergies, asthma, etc.). Please explain. _____________________________________________________________________________ _____________________________________________________________________________ B. Special medication which may affect performance. Please explain. _____________________________________________________________________________ _____________________________________________________________________________

_________________________________________ Parent/Guardian’s Signature

Date

ISK Admission Packet - 14 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

CONTRACT FOR ACADEMIC YEAR _______ - ________

Child’s Name (LAST, first, middle) ____________________ Grade ____ Date ______________ This contractual agreement is being entered into by the Board of Trustees of the International School of Krakow, as represented by Erica T. Mazzeo, Director of ISK and _________________________________ Parent’s/ Guardian’s name

Services rendered by the school for the aforementioned child(ren) are for appropriate English language grade level instruction each day Monday – Friday for the Academic Year _______ _______, excepting school designated holidays and emergency school closures. In consideration of these services, the parent(s)/ guardian(s) shall provide the following to the school: 1. Pertinent school records for placement and review prior to full acceptance. This shall be waived if the child(ren) has/have already been enrolled. 2. Medical records indicating appropriate vaccinations, inoculations and physical examinations have been performed and found the child to be in good health. 3. Emergency information in case of need for immediate contact. 4. Signed forms: As included in the current Admissions Packet 5. Payment of agreed upon fees.

ISK Admission Packet - 15 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org TUITION AND FEE SCHEDULE All amounts in this document are in Euros. The School’s Fiscal Year running 1 July _______ to 30 June _______. One time only:

Application – E 200

Annual Tuition:

Nursery - 4,815 Euro Pre School – 7,597 Euro Grade 0 – Grade 12 – 11,449 Euro

Name (Last, First, Middle): _______________________________________________________ Address: ______________________________________________________________________ Zip-Code: _______________ Country: ____________________ Please mail the invoice to: ________________________________________________________ _____________________________________________________________________________ I would like to have the invoice e-mailed to: ________________________________________ The name of the contact person is: ______________________________ Telephone number: _______________________

Important Note: Should a student(s) be withdrawn from the school without sufficient reason, the tuition fees for the entire year will be retained or if not yet paid, requested. Should there be valid reasons for withdrawal (e.g. organizational relocation), continuation of tuition payment is shortened to the end of the current quarter. This must be discussed with the Administrator as soon as possible. Any delay could result in more rather than less cost. The Application Fee cannot be refunded. (Note: the costliest expense for a school is the personnel. They are contracted for an entire year. Budgets are figured on the projection of students enrolled for a full year. Any early and unexpected student withdrawal has an immediate impact on the budget). Due to school financial obligations, the preferred method of payment is one single yearly payment. In cases of need, parents may choose from one of two payment options for the tuition fees (yearly or bi-yearly). It is however, understood and agreed that the actual payment is based upon the full School Fiscal Year running July _______ – June _______. Options for payment plans are merely a convenience set up for the parents/guardians when possible. Please understand that the school depends upon the prompt payment of school fees in order to meet its own obligations in a prompt and timely manner. All tuition payments to the school must be paid in advance of services provided rather than after. Your understanding and cooperation are greatly appreciated.

ISK Admission Packet - 16 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

TUITION INSTALLMENT OPTIONS: The application fee (as applicable) is due on or before August 1st for Yearly or Bi-Yearly payments. I. Yearly: II. Bi-Yearly:

One installment paid on or before:

August 1st

Two installments paid on or before: August 1st, January 1st

The total fees for _____________ for Academic Year _______ - ______ are _________________ Currency for Payment:

 EURO

 PLN

 USD

It should be noted that tuition and fees are quoted in Euro. Therefore, if a currency is exchanged, it will be converted into Euro based on the July 1st exchange rate of the contracted year.

Payment Schedule:

 Yearly

 Bi-Yearly

Parents who enroll child(ren) for any part of the quarter are liable for full fees for the quarter. Non-payment penalty: Any account 30 days overdue will be considered in non-payment and subject to a 300 Euro non-payment Penalty. Furthermore, any parent/guardian whose account falls into arrears by 60 days may have school attendance privileges withdrawn from their child(ren). No records may be forwarded to other schools or given to parents until payment is made in full. Prior to signing this contract, a parent should also read the Parent-Student Handbook for a full understanding of all other student/parent obligations. I/We have read, understood and agreed to this contract and the Parent-Student Handbook requirements. I/We understand that I/We, the parent(s)/ guardian(s) are ultimately responsible for the financial obligations of this contract.

________________________________ Parent/Guardian signature Date

_________________________________ Administrator’s signature Date

ISK Admission Packet - 17 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org STUDENT PLACEMENT AGE

ISK

POLAND

NETHERLANDS

FRANCE

Nursery

Przedszkole

peuterspeelzaal

Toute petite section Petite section de maternelle

Preschool Grade0

Przedszkole Przedszkole

Basisonderwijs groep 1 Basisonderwijs groep 2

6 7

Grade 1 Grade 2

Szkola Podstawowa Szkola Podstawowa

Basisonderwijs groep 3 Basisonderwijs groep 4

Grade 3

Szkola Podstawowa

Basisonderwijs groep 5

Grade 4

Szkola Podstawowa

Basisonderwijs groep 6

Grade 5

Szkola Podstawowa

Basisonderwijs groep 7

11 12 13 14 15

Grade 6 Grade 7 Grade 8 Grade 9 Grade 10

Szkola Podstawowa Szkola Podstawowa Gimnazjum Gimnazjum Gimnazjum

Grade 11

Liceum

Grade 12

Liceum

Basisonderwijs groep 8 Middelbaar Middelbaar onderwijs Middelbaar onderwijs Middelbaar onderwijs (VMBO) Middelbaar onderwijs (HAVO) Middelbaar onderwijs (VWO)

3 turning 4 4 turning 5

Moyenne section de maternelle Grande section de maternelle Year1 Cours Preparatoire ( CP ) Year 2 Cours Eementaire Premiere annee ( CE1)Year3 Cours Elementaire Deuxieme annee ( CE2) Year 4 Cours Moyen Premiere annee ( CM1) Year 5 Cours Moyen Deuxieme annee (CM2) Year 6 Sixieme Year 7 onderwijs Cinquieme Year 8 Quatrieme Year 9 Troisieme Year 10 Seconde Year 11 Premiere( bac de Francais ) Year12 Terminale ( bac) Year 13

Liceum

AGE

ISK

CANADA/QUEBEC

3 turning 4 4 turning 5 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Preschool Preschool Grade0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

Preschool Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

JAPAN

USA

youchien youchien shougakkou 1nen shougakkou 2nen shougakkou 3nen shougakkou 4nen shougakkou 5nen shougakkou 6nen chuugakkou 1nen chuugakkou 2nen chuugakkou 3nen koukou 1nen koukou 2nen koukou 3nen

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

ISK Admission Packet - 18 -

The International School of Kraków

Lusina ul. św. Floriana 57, Krakow 30-698

Tel/Fax: +48 12 270 14 09 E-mail: school@iskonline.org On the Web: www.iskonline.org

ACKNOWLEDGEMENT OF RECEIPT AND REVIEW OF ISK STUDENT POLICY MANUAL

I ________________ (Student Name) have reviewed the Student Policy Manual and agree to honor the conditions herein.

Signed: _____________________________ (Student Signature) _____________________________ (Parent/Guardian Signature) _____________________________ (Home Room Teacher Signature)

Date _________________________

ISK Admission Packet - 19 -