Admission Form Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9 and Submit Order Number STEP 1: Application Documents Required Students attending the ECB-CBS are required to have valid medical insurance while studying at the school. Copy of student’s passport * Recent photo of student * A recent school photo or a passport style photo. Copy of student’s birth certificate * Parents’ Immigration Status * Two complete years of school records * Report cards for the two most recent school years completed. Any school records in languages other than English or French must be officially translated. Confidential School Recommendation Form * This form provides important academic insight about the student. It must be completed and sent directly to the ECB-CBS by the previous school via post, fax or email. The school may release the confidential form to the parent/guardian provided that it is in a SEALED envelope with the school stamp. Medical Information * To be completed by the student’s parent/guardian. Confirmation of student’s medical insurance. Step 2: Student Information Last Name * First Name * Middle Name Preferred Name Date of Birth * Gender * Male Female Nationality(ies) * Country of Birth * Email Address * We strongly recommend that students, and their parents provide the ECB-CBS with a Gmail account email. A Gmail account provides students and their parents free access to the school’s online learning platforms, including Google Docs, free cloud storage, and other digital tools for teaching and learning. Student's Mother Tongue * Second Language Third Language Expected Start Date * (MM/YEAR) Intended Length of Stay Anticipated Grade of Entry * Enrolment Year * 2022/23 2023/24 2024/25 Student lives with * Both parents Parent 1 only Parent 2 only Legal Guardian Host Parent Other, please specify relationship; Step 3: Address Information Current Home Address * Country * City * Postal Code * Telephone * Mobile * Email * Does the student have documentation of Custodial Orders or Legal Orders? * YES, please give details; NO Please note that upon acceptance, you will be asked to provide documentation of Custodial Orders or Legal Orders for confidential review by the EBS-CBS. If documents are in a language other than English or French, please provide an official translation. Details Does/will the student have a sibling(s) at the school? * YES, please indicate which grade(s); NO Indicate which grade(s) Will the student require school bus transportation? * YES NO Will the student apply for the half-day high performance program? * YES NO If YES: The Canadian International Dance Academy. (Please complete the Canadian International Dance Academy Application Form.) The Canadian International Sport Academy. (Please complete the Canadian International Sport Academy Application Form.) Step 4: Educational Background Current School * Location * Dates * (FROM/TO) Grades Completed * Language(s) of Instruction * School Type * Public Private I authorize the ECB-CBS to contact the student’s current school if necessary; * YES NO Previous School 1 Previous School Location Dates (FROM/TO) Grades Completed Language(s) of Instruction Previous School 2 Previous School Location Dates (FROM/TO) Grades Completed Language(s) of Instruction Has the student ever repeated a grade? * YES, please indicate which grade; NO Indicate which grade Has the student ever skipped a grade? * YES, please indicate which grade; NO Indicate which grade Has the student ever participated in an accelerated program? * YES, please indicate which program; NO Indicate which program Has the student ever received any additional learning support? * YES, please indicate what kind of additional support NO Indicate what kind of additional support the student has received Step 5: Languages Level of English Please indicate the student’s level of English: * Beginner (first time using English in school) Intermediate (has completed more than two years of English in school) Advanced (has completed more than four years of English in school) Mother Tongue (has always used English in school without extra support) Can the student speak in English? * Yes No With help Independently Can the student write in English? * Yes No With help Independently Can the student understand English? * Yes No With help Independently Can the student read in English? * Yes No With help Independently If the student’s mother tongue is not English, how long has the student been learning English? Level of French Please indicate the student’s level of French: * Beginner (first time using French in school) Intermediate (has completed more than two years of French in school) Advanced (has completed more than four years of French in school) Mother Tongue (has always used French in school without extra support) Can the student speak in French? * Yes No With help Independently Can the student write in French? * Yes No With help Independently Can the student understand French? * Yes No With help Independently Can the student read in French? * Yes No With help Independently If the student’s mother tongue is not French, how long has the student been learning French? What is the student’s mother tongue? * What is/are the parent(s)/guardian(s) mother tongue(s)? * What languages are spoken at home? * Is the student learning to read or write in a language other than English or French? * YES, please give details; NO Give details Would you like the student to study another language at school? * YES, please indicate what languages; NO Indicate what languages Step 6: Medical Information Students attending the ECB-CBP are required to have valid medical insurance while studying at the school. Medical Insurance Provider * Policy Number * Phone Number * Email Address * Is the student currently receiving any medical treatment? * YES, please give details; NO Details Does the student regularly take a prescription drug? * YES, please give details (including dosage); NO Details Does the student have any known allergies? * YES, please give details; NO Details Does the student have any past medical history of illnesses or admissions to hospital that the school should be aware of ? * YES, please give details; NO Details Has the student ever had any of the following? Chicken Pox Measles Mumps German Measles Tuberculosis Scarlet Fever Please provide any further information, as necessary: info headaches Headaches, earaches, please give details. Details info diabete Diabetes, please give details. Details info epilepsy Epilepsy, seizures, convulsions, please give details. Details info serious injury Serious injury, please give details. Details info surgery Surgery, please give details. Details info attention deficit Attention Deficit Disorder, please give details. Details Is the student required to receive medical treatment during school hours? * YES, please give details; NO Details If any of the following conditions apply, please give details: Hearing problems: * YES, please give details; NO Details Vision problems: * YES, please give details; NO Details Physical disability: * YES, please give details; NO Details Special Diet: * YES, please give details; NO Details Please note that upon acceptance, you will be asked to provide a detailed medical form completed by the student’s medical doctor. Authorization for Medical Treatment By ticking all the boxes, you authorize your child to receive medical treatment in the event of a serious accident or emergency and you understand and agree that the ECB-CBS does not assume responsibility. In the event of a serious accident or emergency, the School will immediately contact the parents/guardians, and any other designated emergency contact * I understand and agree If it is considered that hospital treatment is necessary for an injured or ill student, and the School cannot communicate immediately with the parents/ guardians, the School will arrange for the student to be taken by ambulance or private automobile to the emergency ward of the nearest hospital for medical treatment. * I understand and agree The ECB-CBS does not assume responsibility for any injury or damage that may arise with such authorized emergency medical treatment. * I understand and agree I have read and understand the Authorization for Medical Treatment. My signature on the application form confirms that I authorize my child to receive medical treatment in the event of a serious accident or emergency. * I understand and agree Step 7: Learning Support The ECB-CBS will make every effort to accommodate a student’s special learning needs. Students who require one-on-one classroom support may be assigned a private special education specialist at an additional cost to the family. To enable us to make the most appropriate placement for the student, we require the following information. Does the student have any special learning needs? * YES, please give details; NO Details Has the student received any extra support in a previous school? * YES, please give details; NO Details Has the student ever received? Psycho-educational Assessment: * YES NO If YES, at what age? Counseling: * YES NO If YES, at what age? Speech and language therapy: * YES NO If YES, at what age? Other (please give details) Does the student require or have any previous documentation of the following? Student Learning Plan (SLP): * YES, give details; NO Details Individual Education Plan (IEP): * YES, give details; NO Details Applications for students with diagnosed special education needs must include all relevant diagnostic and evaluation documentation for confidential review by the ECB-CBS. If documents are in a language other than English or French, please provide an official translation. Step 8: Parent / Guardian Information If you are a legal guardian, you must provide documentation authorizing guardianship. If documents are in a language other than English or French, please provide an official translation. Parent / Guardian 1 Gender MR. MRS. MS. Other Family Name * First Name * Nationality(ies) * Current Home Address (if different from student) City Country Postal Code Telephone * Mobile * Email Address * Relationship to student * Father Mother Stepfather Stepmother Other If other, please specify relationship; Lives with student? * YES NO What is your intended length of stay in France; Will your employer pay the school tuition fees? * YES NO If YES, what percentage of the school fees will be paid by your employer? Employer * Job Title * Address of Employer * Telephone * Email * We strongly recommend that students, and their parents provide the ECB-CBS with a Gmail account email. A Gmail account provides students and their parents free access to the school’s online learning platforms, including Google Docs, free cloud storage, and other digital tools for teaching and learning. Parent / Guardian 2 Gender MR. MRS. MS. Other Family Name * First Name * Nationality(ies) Current Home Address (if different from student) City Country Postal Code Telephone Mobile Email Address * We strongly recommend that students, and their parents provide the ECB-CBS with a Gmail account email. A Gmail account provides students and their parents free access to the school’s online learning platforms, including Google Docs, free cloud storage, and other digital tools for teaching and learning. Relationship to student Father Mother Stepfather Stepmother Other If other, please specify relationship; Lives with student ? YES NO What is your intended length of stay in France? Will your employer pay the school tuition fees? YES NO If YES, what percentage of the school fees will be paid by your employer? Employer Job Title Telephone Address of Employer Emergency Contact 1 Name * Relationship to Student * Telephone * Mobile * Address * Emergency Contact 2 Name Relationship to Student Telephone Mobile Address Out-of-Town Emergency Contact Name * Relationship with Student * Telephone * Mobile * Address * Parent / Guardian Statement Please write a brief statement about your family, including: - Your reasons for choosing the ECB-CBS; - Your hopes and expectations of the school; - Your hopes and expectations for the student; - Your assessment of the student’s strengths and weaknesses; - Any other information or areas of concern that you feel the schoolshould be aware of. Parent / Guardian Statement Step 9: Declaration Please read carefully. I agree that the family contact information may appear in the school directory (issued to parents only). * YES NO I agree that photographs or video recordings taken of the student during school activities may be used for school publications and website purposes. * YES NO I agree that the student’s schoolwork may be used for school publications and website purposes. * YES NO I have read and understand the Authorization for Medical Treatment. My signature on the application form confirms that I authorize the student to receive medical treatment in the event of a serious accident or emergency. Declaration By ticking all the boxes below, you have read, understood and accepted the school’s terms and conditions. I declare that the information provided on the application form and the enclosed documents is accurate and complete. No information has been withheld. I understand that the failure to disclose relevant information may lead to the withdrawal of an offer of admission or the exclusion of the student from the ECB-CBS. * I understand and agree I understand that the application fee of 1000 € is non-refundable should my child not be admitted to the school, or should I withdraw the application. I understand that completing the application process does not constitute acceptance. * I understand and agree I have read and agree to the application procedure and to the tuition and activity fees’ schedule. I understand that upon acceptance to the ECB-CBS, I must sign the Offer of Admission, and submit the Registration Deposit to confirm the student’s enrolment. * I understand and agree I understand that the students at ECB-CBS are expected to wear the proper school uniform at all times. Uniforms are required to be worn on school field trips, activities and events, as well as school functions. The cost of the uniform is the responsibility of the student and their families. Students are expected to order their uniforms from the supplier chosen by the school. * I understand and agree I declare that I have read and understand the school’s terms and conditions as set forth in the admissions information. My signature on the application form confirms that I have read and agree to the terms and conditions. * I understand and agree Date * (dd/mm/yyyy)
