Enrollment Application

Please complete one form for each student applying for enrollment

Section I - Student information

  Student name     Grade     DATE OF ENTRY 
                                             (as it appears on birth certificate                                                                                                    MM/DD//YYYY

  SEX       DATE OF BIRTH        CITIZENSHIP 
                                                               MM/DD/YYYY

  LANGUAGE STUDENT SPEAKS AT HOME     OTHER LANGUAGES SPOKEN 

SECTION II - PARENT / GUARDIAN INFORMATION

 FATHER'S FULL NAME
 		  

 

  MOTHER' FULL NAME
 
RESIDENTIAL ADDRESS 
 

 

 RESIDENTIAL ADDRESS
 HOME TELEPHONE   

 

  HOME TELEPHONE 
 EMPLOYER   

 

  EMPLOYER 
 OFFICE PHONE   

 

  OFFICE PHONE 
 CELL PHONE   

 

  CELL PHONE 
 E-MAIL   

 

  E-MAIL

SECTION III - EMERGENCY CONTACT INFORMATION

  EMERGENCY CONTACT NAME    OFFICE PHONE 

  HOME PHONE             CELL PHONE 

  DOCTOR'S NAME      DOCTOR'S PHONE 

  SECTION IV - CONSENT

I give permission for my child to receive first aid at school and any emergency treatment considered necessary at the dispensary with the following exceptions noted below. 
No Exception         Exception 

I understand that I have the right to review my child's records and that a copy of the school and health records will be released to the next school he/she attends (exclusive of colleges and universities) without further approval.  I agree.

  SECTION V - SPECIAL SERVICES

Please respond to the following questions to help school personnel plan a program that will best meet your child’s needs. 

            Yes      No    If yes, explain 

1.  Are there any special health problems about which the school should know?   Please explain, if yes   

 

 		  
2.  Does your child have a health problem that requires medication?  Please  explain, if yes.  
3.  Has your child previously received therapy for speech or language development?  Please explain, if yes  
4.  Has your child previously been enrolled in any type of special education program or service?   
5.  Do you suspect that your child may need some type of assistance with his schooling? Please explain, if yes.  

                                                                                 

 If you wish to give other details, please use the following lines:

 

 When will your child be available in Panama to take the admission test and interview?                                                                                                                                                      MM/DD/YYYY
  Do you have other children attending Balboa Academy?   Yes      No   

 Why do you want your child to attend Balboa Academy? (Briefly explain)

 

 Do you desire to have your child transported to and from school by the Balboa Academy bus contractor?

   No      Yes     Pickup address 

 

 I verify that the above information is correct.  

        

Parent or Guardian                                    Date