Registration Date:

New Student

Returning Student

Class for September 2012:

Full Day Program: Sun. Thurs. 8:00am 1:45pm Afternoon Session: Sun. Thurs. 2:15pm 4:15pm

CANADIAN ACADEMY OF LIBYA 2012/2013 STUDENT APPLICATION FORM

Serraj Road Serraj Tripoli, Libya Telephone: +218 92 3010198 Email: [email protected] Website: www.canadian.ly

Childs Name:
Last First Middle

Boy Place of Birth:

Girl

Birth Date:
Month

/
Day

/
Year

Primary Language spoken at home:

Home Address:

Street

Home Phone

City

Email Address:

Mother

Father

Last Name

First Name

Last Name

First Name

Cell Number

Cell Number

Work Telephone Number

Work Telephone Number

Work Place / Occupation

Work Place / Occupation

Names of other Children in your home:

Grade: _

Grade:

1
CAL Application Form 2012-2013 Standard 1.0

EMERGENCY & HEALTH INFORMATION Emergency Contact

- (alternative person to contact in case of emergency, if parents unavailable)

Relationship to child

Name

Home Phone Number

Cell Phone/Other Phone Number

Childs Personal Health #:

Family Doctor:

Doctors Phone #:

Please list any medical concerns that the school needs to be aware of, including allergies, medications, psychological and/or physical special needs, learning disabilities, etc.:

Immunization Records
Please provide a photocopy of documentation confirming your childs dates of immunization. Immunizations include DPT/IPV/HIB (1 & 2), and MMR, DPTP or QUAD (Kindergarten booster).

Allergy Information (where applicable)

My child has no allergies

It is the parents responsibility to provide guidance to the school with respect to the prevention of and treatment of allergic reactions. Please ensure that the school office and your childs teachers have received specific instructions PRIOR to your child attending classes in September.

My childs allergies are NOT life threatening. He/She is allergic to

My childs allergies ARE LIFE-THREATENING. He/She is allergic to

IF YOUR CHILD SUFFERS FROM LIFE THREATENING ALLERGIES, IT IS ESSENTIAL THAT YOU COMPLETE THE SCHO O L S ALLERGY INFORMATION FORM(S) AND PERSONALLY INFORM YOUR CHILD S TEACHER.

2
CAL Application Form 2012-2013 Standard 1.0

Child Custody Information (if applicable)

Name of parent who has legal custody of child

Name of other parent

Custody / access restrictions (if applicable)

If there is a Custody Order, Restraining Order or any other Order in place that pertains to the custody and/or access of the child, a copy of the Order(s) is to be attached to this Application Form.

Privacy Act
I consent to having Canadian Academy of Libya collect personal information that may include student identification information, birth certificate, legal guardianship, court orders if applicable, parents work numbers and e-mail addresses, behavioural, academic and health information, most recent report card, emergency contact name and number, doctors name and number, health insurance number and any similar information needed for registration.

I further consent to the use and disclosure of information contained in this form and otherwise collected by or on behalf of Canadian Academy of Libya (1) for the purpose of establishing, maintaining, and terminating the students or parents relationship with Canadian Academy of Libya, (2) for additional purposes identified when or before personal information is collected, and (3) as otherwise provided in Canadian Academy of Libyas Personal Information Privacy Policy, a copy of which is available on request. I also consent to the collection, use and disclosure of such personal information by and to agents, contractors and service providers of Canadian Academy of Libya.

This information is required in order to register your child at this school and assist the school authority in making an informed decision as to your childs suitability and appropriate placement in the school. It will also allow the school to respond immediately to an emergency. For more information you may contact the schools Principal.

I consent to the following (please check applicable boxes below):

Class List (My childs name, address and phone number included on the Class List for his/her grade) I consent to photographs and work samples of my child to be used in: Yearbook/Scrapbook Newsletter/Website/Promotional Material In-school Parent Presentation

Signature of Parent or Guardian

Date

3
CAL Application Form 2012-2013 Standard 1.0

PARENT AGREEMENT
I, the undersigned, agree to the following:

1. 2. 3. 4. 5. 6.

To enroll my child at Canadian Academy of Libya for the current school year. To provide the school with all fees and tuition payments prior to the dates they are due. I understand that there is no tuition refund on any of the payments made to Canadian Academy of Libya for the current school year, which includes the LYD 240 enrolment fee. When arriving at school, to deliver my child on time and directly to a staff member, and not to take my child from school without informing a staff member and to pick up my child on time. To notify the school in advance if any person other than the parent/guardian is picking up my child. To advise the school if there are any changes in the family relationship, including any changes to the custody/access of the child. I understand that absences due to illness or holiday and school closures due to severe weather conditions and/or natural disasters are not exempt from payment. To keep my child from school if there is any question of illness; to notify the school about any serious illness; and to call the school if my child will be absent from school. That permission is granted to call a physician or ambulance in case of an accident.

7. 8. 9.

10. The school reserves the right to release a child if the school decides it is best for the child and/or the school. 11. To ensure that your child has a positive school experience, there will be a phase-in schedule for the month of September. A copy of the schedule will be provided to you before September. 12. To purchase the school uniform and to be sure that my child wears their uniform to school.

Parent or Guardian Signature

Date

I hereby certify that all the information given regarding my childs registration is deemed complete and correct.

Signature of Parent or Guardian

Date

4
CAL Application Form 2012-2013 Standard 1.0

Canadian Academy of Libya

PRE-KINDERGARTEN & KINDERGARTEN FEE STRUCTURE School Year 2012/ 2013

ANNUAL TUITION Full Day Program: Sunday Thursday 8:00 AM 1:45 PM

Payment Schedule

Enrolment Fee Annual Tuition

LYD 470.00 per month x 9 months (Sept. 9 2012 May 30 2013)

LYD 240.00 LYD 4,230.00 LYD 3,760.00

Discounted Annual Tuition, if paid in full by October 1, 2013

ANNUAL TUITION Afternoon Session: Sunday Thursday 2:15 PM 4:15 PM;

Payment Schedule

Enrolment Fee Annual Tuition

Waived, if student also enrolled in Full Day Program

LYD 240.00 LYD 1,800.00 LYD 1,600.00

LYD 200.00 per month x 9 months (Sept. 9 2012 May 30 2013)

Discounted Annual Tuition, if paid in full by October 1, 2013

Bus transportation to and from school will be provided, at cost. There may be additional fees for field trips, hot lunches (1 day per month; full day program only), as applicable.

5
CAL Application Form 2012-2013 Standard 1.0

PAYMENT TERMS & CONDITIONS

1. A fee of LYD 240.00 (non-refundable) is required on registration. 2. Acceptance of a child for entry is at the discretion of the school. A child must satisfy the Head Teacher (by taking an entry test or by other such means as she shall require) that his or her level of work and behaviour have reached the School's required standard. 3. The school reserves the right to alter the fees from time to time. Such alterations will be notified to parents in writing in advance. 4. All fees are payable in full in advance by no later than the first day of each month of the academic year. The school reserves the right to charge an administration fee of LYD 50 on all invoices and reminders on fees not paid by the due date. The school may look to either parent for payment of fees. 5. In the event of the fees remaining unpaid by mid-month, the school reserves the right to remove the pupil's name from the register forthwith. 6. At least a full months period prior notice in writing given not later than the first day of the month, or payment of a months fees, is required before the removal of a child from the School. Unless such notice is given, the payment of full fees for the next month will be required in all cases. A month's fees will also be payable if, after acceptance of a child for entry, s/he does not enter at the agreed time and the school does not receive at least one month's prior notice of such a decision. 7. The school reserves the right to require the removal (permanent or temporary) of a child at such time (whether immediate or subsequent) as the Head Teacher may stipulate if, in her opinion, the interests of the school demand it. A pro-rata proportion of fees, less an administration charge, may be refunded in such circumstances. 8. Payment of invoices in respect of extras for students who have left the school is due immediately. 9. No remission of fees for the whole or any part of the month can be allowed by absence through illness, infection or any other cause. Parents may consider taking out insurance against such eventuality. 10. Only Cash or Certified Cheque will be accepted
We understand and agree to these payment terms and conditions and to the disclosure of any confidential information to any third parties as may be required to process the payments, in accordance with Canadian Academy of Libya rules.

Dated this
Authorized Signatory (signature)

day of
Name (please print)

, 20

Authorized Signatory (signature)

Name (please print)

6
CAL Application Form 2012-2013 Standard 1.0

Canadian Academy of Libya

Fostering the Creative Child

LEGAL RESIDENCY OF PARENT FORM A

This form is required by the school to be completed and submitted, together with all necessary documentation, at the time of registration.
This form is not required if it has been previously completed and all documentation has been provided to Canadian Academy of Libya.

*** PLEASE ATTACH A COPY OF YOUR CHILDS BIRTH CERTIFICATE. ***

To be completed and signed by ONE parent or legal (court appointed) guardian. If legal guardian, attach a copy of court order appointing you as legal guardian. 1. I am lawfully admitted to Libya (please one); Libyan citizen born in Libya, please provide Family Booklet/documentation Libyan citizen not born in Libya (please attach a photocopy of citizenship paper/card) Permanent Resident (please attach a photocopy of valid documentation) Lawfully admitted to Libya under one of the following documents (please mark the appropriate box below and attach a photocopy of documents):
Employment authorization (working permit) issued for one year A person carrying out official duties as a diplomatic or consular official (with a foreign representative acceptance counterfoil in his/her passport) Other Document description:

2. Yes:

Residency of Tripoli (please one): Residency address:

No:

I am not a resident of Tripoli

3.

Confirming Signature: Parent/s Legal Guardians Name

Parent/s Legal Guardians Signature

Date: 7
CAL Application Form 2012-2013 Standard 1.0

CANADIAN ACADEMY OF LIBYA

Fostering the Creative Child

PERMISSION FORM 2012-2013

Date: I hereby give permission for my child,
Students Name

Student Grade:

to participate in the following activities at Canadian Academy of Libya, to be transported to and from these activities by the bus company that Canadian Academy of Libya contracts with, and to be transported short distances by Canadian Academy of Libya staff. Students are always accompanied by their teacher, or a Canadian Academy of Libya Staff Member, when leaving the school premises during school hours. BUS TRANSPORTATION Where students participate in events off the school premises they are transported by a professional bus company. Occasionally, if there is a small group of students to transport to a local facility, students may be transported in Canadian Academy of Libya Staff vehicles. PE CLASSES Physical Education classes are held outside the school buildings/villas within the school grounds. There are three primary play areas: 2 each are adjacent to each building/villa, and there is a large play area in the front of the property. Students also have an opportunity to play outside during recess and at other times, as appropriate. COMMUNITY PARKS, BUSINESSES, CULTURAL FACILITIES On occasion, students also visit other facilities within the community. One example of these might be a visit to a local grocery store as part of a health and nutrition unit DISMISSAL AWAY FROM THE SCHOOL In most cases, students will travel to and from the above facilities by the methods of transportation mentioned. On some occasions, students will be dismissed directly from these facilities. Parents will be notified in advance if this is the case. Please note that if parents do not arrive to pick their child up within the 10 minute dismissal time, the students may return to the school with one of the teachers. This should only occur in the case of an emergency where the parent is unable to arrive promptly at pick-up time.

Parent or Guardian Signature

Date 8

CAL Application Form 2012-2013 Standard 1.0