2016/17 STUDENT
APPLICATION FORM
Date received:
OFFICE USE ONLY
Application Fees received:
Attach
Photo Here
Start date:
(Please Print)
STUDENT INFORMATION
Last name:
First name:
Date of Birth:
mm / dd
Gender:
/ yy
qM
Preferred name:
Nationality:
HK Permanent Resident:
qF
q Yes
Intended date of admission:
q No
Home address:
mm / dd
/ yy
Home phone no:
First language:
Other language/(s):
Who will be accompanying the student (Infant and Toddler):
PARENTS/GUARDIAN INFORMATION
Name of Father:
Name of Mother:
Father’s Mobile:
Mother’s Mobile:
Father’s Office Telephone:
Mother’s Office Telephone:
Father’s e-mail:
Mother’s e-mail:
Name of Guardian/Helper:
Guardian’s/Helper’s Mobile
PERSONS AUTHORISED TO COLLECT CHILD (TRANSITION AND PRESCHOOL)
Name:
Mobile:
Name:
Mobile:
MEDICAL AND OTHER NEEDS
Does the applicant have any allergies, prescribed medication, health or physical concerns?
q Yes
q No
If yes, please give details:
Any other medical issues?
Name of Emergency Contact:
Emergency Contact’s Mobile:
Please inform us if there are any special circumstances (such as death of one parent, separation, adoption etc.) that may affect your child
22/F Park Commercial Centre 180 Tung Lo Wan Road Tin Hau
www.fairchild.academy Telephone: (852) 2898 1611
Fax: (852) 2874 9800
E-mail: [email protected]
st
nd
rd
Please indicate your preference by writing your 1 , 2 , 3 choice in the box provided for both time and days.
PROGRAM
INFANT
•
•
•
6-12 months
60 minutes
Child and caregiver attend
together
INFANT
•
•
•
12-18 months
60 minutes
Child and caregiver attend
together
CLASS SCHEDULE and FEES
One day per week
Monday
☐ 11:00-12:00pm
Wednesday
☐ 2:00-3:00pm
One day per week
Friday
☐ 2:00-3:00pm
Saturday
☐ 1:00-2:00pm
*HK$1,340 per 4 sessions
*HK$1,340 per 4 sessions
One day per week
Saturday
☐ 9:30-10:30am
☐ 1:15-2:15pm
•
•
•
18-28 months
90 minutes
Child and caregiver attend
together
One day per week
Monday
☐ 2:00-3:30pm
Saturday
☐ 11:00-12:30pm
*HK$3,730 per 12 sessions
Two days per week
Tuesday and Thursday
☐ 8:45-10:15am
☐ 11:00-12:30pm
☐ 2:30-4:00pm
Wednesday and Friday
☐ 2:30-4:00pm
Three days per week
Monday, Wednesday and Friday
☐ 8:45-10:15am
*HK$5,200 per 12 sessions
☐ More than 3 days/week by
request
*HK$3,590 per 8 sessions
TRANSITION
Two days per week
Tuesday and Thursday
☐ 8:30-10:30am
☐ 11:00-1:00pm
☐ 2:15-4:15pm
24-36 months
2 hours
Child attends on their own
PRESCHOOL
•
•
•
Three days per week
☐ By request
*HK$2,550 per 8 sessions
*HK$1,890 per 4 sessions
•
•
•
*HK$2,550 per 8 sessions
Two days per week
Tuesday and Thursday
☐ 2:00-3:00pm
Wednesday and Friday
☐ 10:45-11:45am
*HK$1,340 per 4 sessions
TODDLER
Two days per week
Wednesday and Friday
☐ 2:00-3:00pm
36-48 months
3 hours
Child attends on their own
Three days per week
Monday, Wednesday and Friday
☐ 8:30-10:30am
☐ 11:30-1:30pm (Dual Language)
*HK$5,980 per 12 sessions
*HK$4,150 per 8 sessions
☐ More than 3 days/week by
request
Three days per week
Monday, Wednesday and Friday
☐ 9:00-12:00pm
Five days per week
Monday to Friday
☐ 9:00-12:00pm
HK$4,500 per month
HK$7,500 per month
1. Classes are scheduled according to enrolment and are subject to change. Thank you for your understanding.
2. * Fees are effective to June 30, 2017 and include payment for actual sessions (not charged when school is closed during holiday period). Preschool paid monthly.
ADDITIONAL INFORMATION (OPTIONAL)
How did you learn of Fairchild Junior Academy:
q Website
q Word of Mouth
q Newspaper
q Advertisement
q Facebook
q Other
What is the educational path that you have chosen for your child?
q International q Local q Unsure
CHECKLIST
A completed and signed Student Application Form
q
One photograph of the applicant (please write applicant’s name on the back)
q
Copy of applicant’s Birth Certificate and/or Passport (with valid HK visa, for non-local family)
q
Copy of applicant’s immunization record
q
Copy of parents’ HKIDs and/or Passports (with valid HK visa, for non-local family)
q
Application Fee $200 (Please make cheque payable to Fairchild Canadian Academy Limited)
q
PARENTAL CONSENT AND ACCEPTANCE
1.
2.
3.
4.
5.
6.
I declare that the information given in this application form is true, complete and accurate.
I understand that only completed applications, including submission of application fee, and all required documents, will be
considered for the processing of my child’s application.
I agree that in the event of medical need, my child should be taken to the nearest public hospital.
I understand that the application fee is non-refundable, non-transferable, and non-deferrable.
I give my consent for Fairchild Junior Academy to use the personal data provided in this form
for the purpose of processing my child’s application.
I give my consent for Fairchild Junior Academy to use images of my child participating in school activities on the Fairchild Junior
Academy website, social media pages, and promotional materials. Please let us know if consent is not given.
Parent/Guardian signature
Date
22/F Park Commercial Centre 180 Tung Lo Wan Road Tin Hau
www.fairchild.academy Telephone: (852) 2898 1611
Fax: (852) 2874 9800
E-mail: [email protected]