Personal Information

Student's Name*

Current Grade*
---Pre-KKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12

Gender*
---MaleFemale

Date of Birth*
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 ---198919901991199219931994199519961997199819992000200120022003200420052006200720082009

Country of Birth*

Citizenship* (indicate if dual)

Languages Spoken at Home*

Previous Schools Attended

Name of Most Recent School*

Dates Attended*
From:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---198919901991199219931994199519961997199819992000200120022003200420052006200720082009
To:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---198919901991199219931994199519961997199819992000200120022003200420052006200720082009

Grades Completed*
From:
---Pre-KKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12
To:
---Pre-KKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12

School Address*

Name of Previous School

Dates Attended
From:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---198919901991199219931994199519961997199819992000200120022003200420052006200720082009
To:
---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---198919901991199219931994199519961997199819992000200120022003200420052006200720082009

Grades Completed
From:
---Pre-KKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12
To:
---Pre-KKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12

School Address

Family Information

List names in order from oldest to youngest

Older Brothers

Younger Brothers

Older Sisters

Younger Sisters

Family Address

Parent/Guardian Information

Primary Parent or Guardian's Name*

Citizenship*

Home Phone*

Home Email*

Company Affiliation

Position

Business Address

Business Phone

Secondary Parent or Guardian's Name

Citizenship

Home Phone

Home Email

Company Affiliation

Position

Business Address

Business Phone

Additional Questions or Comments

I understand my child is accepted conditionally until ALL criteria have been met; i.e., complete previous school records received; completed health records received; initial screening/admissions process completed; proof of birth date.

I authorize the school to administer academic and psychological testing throughout the school year. I understand that I will be notified prior to any psychoeducational testing.

I realize that Colegio International de Caracas does not carry student medical insurance.

I realize that the registration process is not complete until all applicable fees are paid.

I authorize the school to use photographs taken in school to produce web pages, ICT presentations, educational or interest articles or similar. (Please rest assured the student's safety will always be of paramount importance, no personal information will be made public).

 By checking this box, you agree to the above terms.