new student application form – Jeddah Knowledge International School – مدرسة المعرفة العالمية بجدة

Registration / Application Form

Section A - Student Details

Date of Requested Admission*

Age on September 1st

Student Name*

First Middle Last Suffix

Student Name (Arabic)

First Middle Last Suffix

Full Name as it appears in the Passport:*

First Middle Last

Full Name as it appears in the Passport (Arabic)

First Middle Last

Father’s ID as written on the Family Card/Residency Permit (or Iqama):

Student’s ID as written on the Family Card/Residency Permit (or Iqama):*

Date of Birth as it appears in the Passport

MM slash DD slash YYYY

Place of Birth:*

Nationality*

Gender*

Male

Female

Religion*

Muslim

Christian

Other

Student’s Mobile No.:

Student’s Email:

Home Language*

Additional Languages Spoken :

Student resides with:*

Both Parents

Father

Mother

Other

Has the student previously attended Jeddah Knowledge International School?*

Yes

From Year

To Year

Has the student ever skipped a grade level?*

Yes

From Year

To Year

Has the student ever been asked to repeat a grade level?*

Yes

From Year

To Year

Section B - Previous Schools' Attended

Previous Schools Attended

Name

Location

Grade Level

Language of Instruction

From Year

To Year

Section C - Sibling Information

Number of immediate family members including parents:*

Siblings

First Name

Surname

Currently Enrolled at JKS

If Yes, indicate grade/section. If No, indicate the grade and school where he/she is presently enrolled.

Section D - Relatives At The School

List the names of all relatives at JKS.

Student Name

Grade Level

Relationship

Section E - Father’s Information

Father Name

First Middle Last

Home Language

Additional Languages Spoken

Nationality

Tertiary Education:

Degree

University Attended

Father’s Job/Profession/ Work:

Contact Details

Company Name Street / Building / Floor P.O. Box Town / City: District: Country

Home Address

House / Apartment No.: Street / Building / Floor P.O. Box Town / City: District: Country

Work Phone

Home Phone

Mobile

Work Email

Personal Email

Section F - Mother’s Information

Mother Name

First Middle Last

Home Language

Additional Languages Spoken

Nationality

Tertiary Education:

Degree

University Attended

Mother’s Job/Profession/ Work:

Contact Details

Company Name Street / Building / Floor P.O. Box Town / City: District: Country

Home Address

House / Apartment No.: Street / Building / Floor P.O. Box Town / City: District: Country

Work Phone

Home Phone

Mobile

Work Email

Personal Email

Section G - Guardian’s Information (If Applicable)

Guardian Name

First Middle Last

Home Language

Nationality

Relationship to Student

Tertiary Education:

Degree

University Attended

Guardian's Job/Profession/ Work:

Work Phone

Home Phone

Mobile

Work Email

Personal Email

Section H- Emergency Contact Information (Other Than Parents)

Contact 1

Name*

First Last

Relationship to Student*

Home Phone*

Mobile*

Email*

Contact 2

Name*

First Last

Relationship to Student*

Home Phone*

Mobile*

Email*

Are there any other details you feel we should be aware of in addition to the information already supplied on this form?

Educational Services History

1. Has your child ever received any of the following special support services:

Has your child ever been evaluated by a psychologist, speech/language therapist, educational diagnostician or other specialist?*

Yes

Reason*

Attach Report copy

Max. file size: 256 MB.

Has your child ever been experienced learning / Behavioural Issues (Special Educational Needs)*

Yes

The school needs to be aware of any learning or behavioral difficulties in order to effectively address these issues. Please indicate any such difficulties below, and submit relevant supporting reports. if any are available. Failure to disclose relevant information may make it difficult to offer an effective education to the student.

Reason*

Attach Report copy

Max. file size: 256 MB.

Indicate here details of any physical condition that might impact on your child’s learning (e.g. wearing of heavy and high powered lenses, grommets, glass eye):

Medical Information Sheet

Please complete this form carefully. This form provides essential information in order to provide your child with the best possible school health and emergency care.

Does your child have any of the following

Which health issue does your child have

Does your child take any type of medication?*

Yes

name of medication*

dosage*

duration of the medication*

Kindly note that a medical report must be submitted to substantiate your child’s medical information, approving any medication that he/she is currently taking as well as the doctor’s prescription.

Max. file size: 256 MB.

Doctor Name

First

Doctor Contact Information

Required Immunizations

You are required to submit a copy of your child’s immunization record. Please indicate below if your child has received the following immunizations. Incude dates if available. Photocopies of records are acceptable

DPT

Yes

Year

HIB

Yes

Year

Polio

Yes

Year

MMR

Yes

Year

Yes

Year

Other Immunizations:

I agree to my child’s photograph being in the school’s published yearbook, newsletters, ou001ecial school website, and social media (e.g. Instagram).*

Yes

Required Documents

Financial Contract (English and Arabic) signed by the father or the student’s legal guardian

Drop files here or

Max. file size: 256 MB.

Signed Educational Services History

Drop files here or

Max. file size: 256 MB.

Signed Medical Information Sheet

Max. file size: 256 MB.

Child's Birth Certificate

Max. file size: 256 MB.

Child's Immunization Certificate

Max. file size: 256 MB.

Father's Passport

Drop files here or

Max. file size: 256 MB.

Mother's Passport

Drop files here or

Max. file size: 256 MB.

Student's Passport

Drop files here or

Max. file size: 256 MB.

Family Card/Residency Card (or Iqama). The student must be shown on parent’s Family Card / Residency Card (or Iqama)

Max. file size: 256 MB.

School Transfer Certificate for Transferring Students)

Max. file size: 256 MB.

Reports and Transcripts:

Drop files here or

Max. file size: 256 MB.

Student Recent Photo

Max. file size: 256 MB.

Signature*