Photo

Pre-School and Kindergarten Application FormI prefer the Whole Day Schedule

Regular Schedule

Number of days will attend 3days

4days

5days

Child’s Name
MaleDOB

Female(MM)/(DD)

Beginning Day(MM)/(DD)

Days attending

TM

/(YY)

W

T

Known As
Nationality/(YY)

What Language(s) can your child speak and understandWhat Language is spoken at home?
Home Address
Zip Code-Home Phone (Mother’s Name

Office Hours

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Employer
Position:

am-:

pm

AddressP e r s o n a l

Cell Phone (Father’s Name

Direct Line-Business)

Phone (Office Hours

ＢｕｓｉｎｅｓｓEmployerPosition):am)-:pm

AddressP e r s o n a l

Cell Phone (Direct Line-Business)

Phone ()

Contact If Parents Can Not Be Reached
RelationshipHome Phone ()Personal

Cell Phone ()□ I agree to allow my email address to be added to the school class email directory.
Email Address;
How your child had any experiences in other child care centers or pre-school?
Until what age do you plan to have your child to attend Busy Bees International School?
Which school would you like your child to attend after graduating from Busy Bees?

FPlease list the names and birthdays of other children in your family.
Please comment on your child’s play and interests.

Does your child have opportunities to play with other children his/her own age?
How do you feel your child will react to attend school and be separated from the primary caregiver?
How do you feel your child will benefit from attending Busy Bees?
Where did you hear about Busy Bees?

Who will be bringing your child(ren) to / from school?
Relationship

Name

Photo)

()

Photo

Photo

Please note:

Phone (Photos are required of any non parent / guardian who picks up a child(ren)!

Tuition Payment Method:(Please check one)Monthly

Payment to be paid to the determined account by the end of the previous month.

TermlyThis payment is due and payable on or before the first day of any given term during

the school year.
YearlyThis payment is due and payable in full on or before the first scheduled school daysof any give school year.
All tuition payments and fees are non-refundable.
Busy Bees reserves the right to deny or terminate enrollment when parents do not comply with Busy
Bees ‘Regulations and School Policies’.
I state that we (the guardians / parents) clearly understand, agree and will comply with Busy Bees
‘Regulations and School Policies’.
SignedRelationship

Date:(MM)

/(DD)

/(YY)

Busy Bees International

Pre-School and Kindergarten

MEDICAL FORM
This medical form is to be completed and returned to school with the application form.

Child’s NameNationality
Insurance Company

Birth Date (MM)Child’s Passport Number
Policy No.

(DD)

(YY)

Note: Please attached insurance copy

Name of family doctor
Address

Phone ()

Any serious illnesses/accidents since birth?
Allergies(to plants, foods, medications, etc.) ? Please specify

Under any medical treatment of therapy at present or past?
(Other health problem?) Please specify

Recent Immunizations/shots: Please (X) all shots that your child has received.
Diphtheria, Tetanus, Toxoid and Pertussis(DTP,DTaP,Td) , Polio(IPV) ,Measles,Mumps,Rubella(MMR), Pneumoccal Conjugate(PCV7) ,Tuberculosis(TB) , Other:
Additional information that may help us care for your child?
Comments on speech, hearing and sight.
Is your child toilet trained?
Can your child eat by him/her self?
Does your child nap? YesNoFor how long?

Busy Bees International

Pre-School and Kindergarten

FIRST AID, FIELD TRIP PERMISSION
Medical Authorization form for (Child’s Name)
I give Busy Bees International Pre-School and Kindergarten the right to administer first aid to mychild. In case of emergency, I understand that the school staff will promptly contact the parents. If neither
parent nor the emergency phone numbers can be reached and in case of surgical emergency, I give
permission to the physician selected by us and/or the director of Busy Bees International Pre-School andKindergarten to hospitalize and secure proper treatment for my child as named above.

Physician’ Name
Emergency Contact
Emergency Contact
Mother’s Name
Father’ s Name
Preferred Hospital

Phone
Phone

(())

――Phone
Phone
Phone
Phone

(((())))

―――
―(DD)

(YY)

Insurance Type and Number
SignedDate (MM)

Field Trip Permission form for (Child’s name)
I give permission for my child to attend any field trip throughout the school year
under supervision of the Busy Bees International School Staff. This includes special
events, daily walks to neighborhood parks, and short walks around the neighborhood.
SignedDate (MM)(DD)(YY)