APPLICATION FORM Last name: Name: Sex Male Female Date of birth: Nationality: Native language: Other languages: The applicant registers as: A) Regular B) For a set amount of me Date of arrival: Lenght of stay: Has the child previously resided in the preschool institution? Name and place of the previous preschool institution: Names and ages of other children in the family: Special health or physical notes related to the child enrolling: A list of foods that a child should not eat for health reasons: Did the child have any illness, prolonged treatment or hospital stay? If so, please clarify. Does the child have a need for regular use of medicaon or adhere to special health measures? Does the student have any allergies and hypersensivity? If so, please list them. Last name: First name: Phone number: E-mail: Occupation: Last name: First name: Phone number: E-mail: Occupation: Who does the child live with (parents, father, mother, guardians)? Who is responsible for tuition costs How did you find out about the Kids Club Preschool? We declare that we agree with all the conditions of enrollment in the preschool institution'Kids Club' and that, if the above-menoned student is enrolled all condions will be met. Date Parent / guardian signature Send
