TiS Student Enrollment Application Form - 2017-18

TiS
Student
Enrollment
Application
Form
For Academic Year: 2017-18.
…
[TiS Student Enrollment Application Form – Academic Year:
2017-18]
APPLICATION FOR STUDENT ENROLLMENT
Please print out the forms below and fill in all the relevant areas.
You may mail them to: The Registrar

Tanarata International Schools
Planters Grounds, 3½ mls Kajang-Serdang Rd.,
Kajang, 43000 Selangor, Malaysia.
how to contact us
For inquiries and/or to schedule a campus visit,
please contact us 
Tel: +60 (03) 8737-7366 Fax: +60 (03) 8734-3848
Email: admin@tanarata.net Website: www.tanarata.net
Tanarata International Schools 2


welcome
to Tanarata International Schools
Dear Parents,
I take this opportunity to warmly welcome you to look at Tanarata International

Schools – TiS for your child’s education. We thank you for considering entrusting
Tanarata with the critical responsibility of your child’s educational preparation and
development. If enrolled, we do assure you that your child will receive a highly
rewarding experience at TiS. We look forward to the opportunity to work with your child
to develop and achieve his or her full potential and talents.
Please be advised that TiS admits students based on various relevant criteria and
considerations, and does place limits on the class size for each teaching level. Students
will be admitted based on these various criteria and considerations, usually including but
not limited to placement test/s. It is strongly recommended enrollment applications be
submitted early as there are limited seats available for many classes. Once your child’s
application is received and placement test/s held, an admission committee will review the
application, and guide you on the appropriate placement for your child if admission is
offered. As admission decisions are generally made 3 to 4 months before the start of the
academic year in September, your child’s application should preferably be submitted
latest by end March (but not more than 12 months prior to intended admission).
To assist you with the enrollment process, we have included below a check list of forms
and documents which are required for enrollment. This completed information will help
us to make admission decisions and the best possible placement for your child. It is
essential that you provide TiS with official documents for the previous two school years.
For secondary school students, this must be an official transcript.
If at any time we can assist you with questions or further clarifications, please do not
hesitate to call us or email us.
Yours sincerely,

The Registrar
ENROLLMENT CHECK LIST
Please complete the enclosed forms and hand in all documents to the school AT THE TIME OF
ENROLLMENT, OR BY THE FIRST DAY OF SCHOOL.
Where circumstances do not permit this, your child may be admitted to TiS without all of this
information; however, enrollment will be provisional until such time as these records are
complete.
 ENROLLMENT FORM (with 2 copies of photographs)

 Recommendation Letter from the parents of at least 1 non-related student of TiS
 TUITION AND FEES AGREEMENT
 PROOF OF PAYMENT OF APPLICATION FEE
 PHOTOCOPY OF IC or PASSPORT or BIRTH CERTIFICATE (Parents and Candidate)
 PREVIOUS SCHOOL RECORDS (for last two years)
 OFFICIAL TRANSCRIPTS
 CURRICULUM VITAE OF BOTH PARENTS
 MEDICAL INFORMATION FORM
 EMERGENCY MEDICAL AUTHORIZATION FORM
 TiS DISCLAIMER AND RELEASE LIABILITY STATEMENT
Admission Eligibility Requirements:
For Malaysians (if required to comply with Ministry of Education’s requirements):

- Applying to MOE (Ministry of Education)
- Applying for transfer from MOE
- Approval from MOE
For Foreigners:
- Apply for Student Pass from Immigration Dept
- Independent Pass or Dependent Pass
Note:
- Malaysian students are eligible to enroll at TiS (without MOE approval) if either of the parents are
non-Malaysians.

- For Malaysian students with both parents being Malaysian, once the completed student
application is received at TiS and found suitable for admission, TiS shall undertake to obtain
the application for admission eligibility from the MOE on behalf of the student (if required).
- For students (non-Malaysian or foreigners) requiring a Student Pass from the Malaysian
Immigration Department of Malaysia, TiS will not undertake the application for the Student
Pass on behalf of the student but will assist in providing any documentation required to obtain
the Student Pass.
- Non-Malaysian students who are currently on a Dependant Pass issued by the Malaysian
Immigration Department, do not need to apply for a Student Pass, and are eligible for direct
enrollment into TiS.
FOR OFFICE USE ONLY
Entry date: Date Application Fee Received: Tuition & Fees Agreement
ESL: Yes / No Passport / Birth Certificate Medical Information Form
Bus: Yes / No Previous School Records Immunization Form
Initial Class Placement: Emergency Medical Authorization Form Field Trip Permission Form

Personal Data Protection Act 2010 (Malaysia)
The Personal Data Protection Act 2010 (“PDPA”) is a legislation that seeks to regulate the processing of
personal data by data users in commercial transactions, and to safeguard the interests of the data subjects.
Personal Data Protection Regulations 2013
These regulations provide some clarification on the following personal data protection principles:-
 General Principle - the consent obtained by a data user from a data subject shall be in any form where
such consent can be recorded and maintained properly by the data user.
 Notice and Choice Principle - the data user must provide the data subject information on how to contact
the data user with inquiries or complaints. The Regulations provide that the information must include the
designation of the contact person, phone number, fax number (if any), email address (if any) and any other
related information.
 Security Principle - the data user must develop and implement a security policy that will comply with the
security standard set out by the PDPA Commissioner. The data user is also under the obligation to ensure that
the security standard in the processing of the personal data is complied with by the data processor that is
carrying out the processing of the personal data on behalf of the data user.
 Retention Principle - the data user must ensure that the personal data of the data subject is retained in
accordance with the prescribed standard.
 Data Integrity Principle - the data user must ensure that the processing of the personal data of the data
subject is in accordance with the prescribed data integrity standard.
In compliance with PDPA Regulations, please note that by submitting this Student Enrollment
Application Form, you give consent to Tanarata International Schools the right to store and use all data
contained therein, and all additional information collected on the students and their parents/guardians, for
the schools’ administration purposes. This includes information on potential, current and former students
and their parents/guardians.
The school reserves the right to provide such data (in either detailed or summarized form) to:-
 Government Agencies such as the Ministry of Education, State Education Department and any other statutory
agencies that the school may be legally required to such as the Immigration Department, Police or Emergency
Services;
 Examination and Accreditation bodies such as Cambridge International Examinations (CIE) etc.;
 Institutes of Education to/from which a student is transferring, particularly in reference to student
testimonials, letter of reference, transcripts etc.;
 Any third parties it may engage or task with or outsource in connection with the operation and management
of the school and services provided (such as ECA Service providers, Holiday Camp and Field Trip
Organizers, Caféteria Operator/s, Transport Operators etc.);
 Any third parties such as those conducting market research and surveys, providing no personally identifiable
data are released.
The school undertakes not to intentionally release personally identifiable information of students and their
parents / guardians to third parties other than for the purposes stated herein and for any other legitimate
purposes. The school will not share, sell, rent, trade and/or disclose your child’s and/or your Personal Data
to any unauthorized third party in contravention of applicable laws unless consent has been obtained from
the parent / guardian of the student/s.

It is the responsibility of the parent/guardian to update the school on changes in your and your child/ren’s
personal information in a timely manner (such as change in contact details, the medical status of the student
etc.) in order for the school to maintain the integrity of its student database so as to be able to act in the best
interest of your child/ren.

STUDENT ENROLLMENT APPLICATION FORM
PERSONAL DETAILS:
Student
STUDENT NAME (as per Passport / ID): Photo
___________________________________________________________ MALE /
FEMALE
as would appear on transcripts: (please circle)
DATE OF BIRTH: ____________________

(day) (month) (year)
NATIONALITY: _________________ Race/Origin: __________________ Faith: ________________
1st LANGUAGE: ______________________________ Beginner

ENGLISH PROFICIENCY: Intermediate
2nd LANGUAGE: ______________________________ Fluent
(please circle)
LANGUAGE SPOKEN AT HOME: ______________________________
HOME ADDRESS (Malaysia):

__________________________________________________________________________________
__________________________________________________________________________________
TEL: _____________________ FAX: _______________________
MOBILE: _____________________
CURRENT E-MAIL ADDRESS: ___________________________________________
REQUESTING PLACEMENT INTO CLASS YEAR / GRADE: _______________________ *

* Parents with students requesting placement into Year 2 and above, please submit a writing sample
(independently completed by the child) which provides the school with an indication of your child’s present
performance level. This can include a sample of work already completed by the child.

INTENDED FIRST DAY OF SCHOOL: ___________________________

Students Interests / Hobbies / Skills:
____________________________________
____________________________________
____________________________________
Recognitions, Awards & Achievements of Student (in Academics, Sports, Music etc.):
_______________________________________________
_______________________________________________
____________________________________________

FAMILY INFORMATION:
FATHER'S NAME AND TITLE / POSITION:
___________________________________________________________________
ORGANIZATION'S NAME & ADDRESS (in Malaysia and/or overseas):
_____________________________________________________
E-MAIL ADDRESS: ___________________________________________
TEL: ___________________ MOBILE: ___________________ FAX: ____________________
Date of Birth: ________________
Nationality: __________________ Race: _________
Languages Spoken and degree of proficiency:

_________________________________________________
Educational Qualifications:-
Degree / Diploma / Cert. Subject Specializations Year obtained University

 Please attach Curriculum Vitae of Father (required).

MOTHER'S NAME AND TITLE / POSITION:
___________________________________________________________________
ORGANIZATION'S NAME & ADDRESS (in Malaysia and/or overseas):
_____________________________________________________
E-MAIL ADDRESS: ___________________________________________
TEL: ___________________ MOBILE: ____________________ FAX:
____________________
Date of Birth: ________________
Nationality: __________________ Race: _________
Languages Spoken and degree of proficiency:

_________________________________________________
Educational Qualifications:-
Degree / Diploma / Cert. Subject Specializations Year obtained University
 Please attach Curriculum Vitae of Mother (required).

CHILDREN LIVE WITH: Both Parents / Father / Mother / Guardian (please circle)

SCHOOLING HISTORY:
Please give details of schools attended, providing TiS with copies of records for the last
two school years (list most recently attended school first):
1) NAME, CITY, COUNTRY OF SCHOOL:
_________________________________________________________
LANGUAGE OF INSTRUCTION: ____________________________________________
DATES ATTENDED: FROM: ____________________ TO: ______________________

day / month / year day / month / year
NAME OF CLASS/GRADE ENROLLED:
AT ENTRY: __________________ ON LEAVING: _______________
2) NAME, CITY, COUNTRY OF SCHOOL:
_________________________________________________________
LANGUAGE OF INSTRUCTION: ____________________________________________
DATES ATTENDED: FROM: ____________________ TO: ______________________

day / month / year day / month / year
NAME OF CLASS/GRADE ENROLLED:
AT ENTRY: __________________ ON LEAVING: _______________

I initially found out about TiS from: (check all that apply)
___ Website ___ Friend
___ Company ___ Embassy
___ Last school ___ International Directories

Directory Name: _______________________
Other (please specify): __________________________________________
SIGNATURES:
Father: _____________________________________
Mother: _____________________________________

FINANCIAL INFORMATION:
Please note that parents are responsible for tuition payments, regardless of whether or
not they are reimbursed by their employers.
Fees will be paid by:
1. Employer (name) __________________________ Employer pays _______

%
2. Self _________%
3. Other ______________________________________________________
If you do not want invoices sent home with your child, to what address would you like
them to be sent?

SPECIAL SERVICES INFORMATION
If your child(ren) has ever received any special services such as learning support or
counseling, please complete this form and return it with the TIS Enrollment Form.
1. Has your child ever been diagnosed with a learning disability, behavioral or
emotional disability or any other physical or mental disability? Yes / No (circle
one)
2. Has your child ever received any of the following special services?
(indicate Yes or No)
a) Learning disability program _______

b) Other remedial program _______
c) Speech/Language Therapy _______
d) Counseling _______
e) Gifted/Talented/Honors program _______
f) Physical or Occupational Therapy _______
g) Limited vision and/or hearing program _______
h) Other _______
3. Has your child ever been evaluated by a psychiatrist, psychologist,

speech/language therapist, educational diagnostician or any other specialist?
Yes / No (circle one)
4. Has your child ever repeated a class/grade in school? Yes / No (circle one)
If yes, which class/grade? ________
5. Please describe those strengths or weaknesses that your child’s teacher(s)

should know in order to assist him/her.
If you have checked any of the above, please provide details below AND submit
copies of any reports to TiS.
Disabilities: TiS does not have a program for students with a learning disabilities, behavioral or emotional
disability or any other physical or mental disability. Since services for students with disabilities are not
available, TiS cannot provide for students with disabilities.
Please be advised that any placement at TiS is conditional on the student’s ability to perform satisfactorily in
the grade level and/or program assigned. Should a parent/guardian not disclose any known disabilities of
the child, the school reserves the right to disenroll the child if admitted.

SIGNATURES:
Father: ______________________________
Mother: _____________________________

TiS TUITION FEES 2017-18
The school requires an Application Fee of RM 750/- to cover the administration cost of
processing a student’s application for enrollment.
When the student is granted admission / enrollment by the school, a once only
Admission (or Entrance) Fee is payable as well as a refundable Deposit to confirm
enrollment at the school, as follows:-
Class / Year Admission Fees Deposit (refundable)

Yr 1 – 2 RM 3,500 RM 3,000
Yr 3 – 4 RM 4,000 RM 3,250
Yr 5 – 6 RM 4,500 RM 3,500
Yr 7 – 9 RM 5,600 RM 3,750
Yr 10 – 11 IGCSE RM 7,000 RM 4,000
Yr 12 – 13 AS/A RM 7,500 RM 5,000
Levels
 NOTE: The Deposit is refundable only if the student leaves after giving a terms (i.e. 4 months) notice to the
school in writing.
A Resource Fund Contribution of RM 600.00 per term (payable for 12 terms – or 4

years) is also payable along with Tuition Fees and which is payable on a termly basis.
(Note: There are 3 terms in an academic year).
The schools Tuition Fees (payable on a termly basis), with effect from the start of the
academic year, are as follows:-
Tuition Fees
Class / Year Tuition Fees Tuition Fees Tuition Fees

2017-18 2018-19 2019-20
Yr 1 – 2 RM5,460 RM5,880 RM 6,300
Yr 3 – 4 RM5,850 RM6,300 RM 6,750
Yr 5 – 6 RM6,240 RM6,720 RM 7,200
Yr 7 – 9 RM6,760 RM7,280 RM 7,800
Yr 10 – 11 IGCSE RM8,060 RM8,680 RM 9,300
Yr 12 – 13 AS/A RM9,360 RM10,080 RM 10,800

Levels
* A 10% discount on Tuition Fees for siblings of a current student is applicable.

Note:
 Term Schedule: There are 3 terms (September, January, April) per year.
 Fee Payment Schedule: The Tuition Fee’s and Building-Facilities Fund
contributions are payable 30 days before the start of each term – which starts on
January, April or September respectively in the academic year. Students who are
admitted to the School in the second half of any term are charged half (½) the
basic term fee. No further reduction is given however late into the term the
student is admitted. Should a student be leaving school during term, the terms
fees are not refundable. Students leaving the school are only eligible for refund of
the Deposit sum if one terms (i.e. 4 months) prior written notice of disenrollment is
given to the school.
 Late Charges: All fees must be paid by the due date i.e. no later than 30 days
before start of term. Late payments are subject to a cumulative late payment
charge of five (5) percent per month (after two weeks have elapsed from the
due date) of the basic term fee being imposed, and shall result in the student not
being allowed to continue attending classes until the account is brought up to
date.
 Family Discount: A full basic term fee will be charged to the eldest child of a
family, but a ten (10) percent discount on the basic term fee will be granted to
each subsequent child. This applies to both the Primary and Secondary Divisions.
 Fee Adjustments: The school does not follow the practice of automatic annual fee
increases. Fees will generally be reviewed on a periodic or annual basis by the
school’s management, and shall take effect as and when warranted.
 Miscellaneous Costs / Fees: This would include the cost of uniforms, text
books, exercise books, and organized activities that involve external third party
instructors / service providers / suppliers e.g. Karate, Drama, Ballet, Tae-Kwan-
Do, etc. These costs are paid directly to the instructors / service providers /
suppliers and not to the School unless notified by the School of any change in
payment plan.
PAYMENT PROCEDURES FOR TUITION AND FEES
Payment may be made by a cheque drawn on a local bank and denominated in Ringgit Malaysia (RM), via
direct bank transfer to the school’s bank account, or by a cash deposit of RM at the school’s bank. A copy
of the transfer document should be provided the schools registrar.
Any bank charges incurred by the school from payments other than according to the above instructions will
be charged to the student’s account.
Tuition and fees are to be payable by the invoice due date. Late payment penalties shall be applied as follows:-
After 15 days beyond the invoice due date: 5% cumulative late payment charge applied on outstanding

amounts.
After 30 days beyond the invoice due date: all student records will be withheld by the school, with automatic
prohibition of the student to attend classes / schools.
All tuition and fees are subject to an increase without notice, at the discretion of the Board of Directors
of Tanarata International Schools. For further information, please contact the TiS Registrar at:
Email: admin@tanarata.net or at the contact numbers listed at the schools website  www.tanarata.net
TiS ENROLLMENT & TUITION FEES AGREEMENT
FINANCIAL OBLIGATIONS OF PARENTS
1. Tuition & Other Fees:

Parents of students enrolled at the Tanarata International School (TiS) are required to
pay tuition and other fees as outlined in the tuition and fees information sheet (and in
any future fee revisions) in a timely manner.
2. Miscellaneous Expenses:
During the course of the academic year, there may be some miscellaneous expenses
that are not outlined in the Tuition and Fees information sheet, but will be charged to the
parents. Examples include optional Extra Curricular Activities, field trips, physical
education T-shirts, computer classes etc.
PERSONAL DETAILS
STUDENT’S NAME: _________________________________________________
(last) (first) (middle)
STUDENT’S NAME: _________________________________________________
STUDENT’S NAME: ___________________________________________________

FATHER’S NAME: ________________________________________
MOTHER’S NAME: ________________________________________

TERMS AND CONDITIONS
1. All tuition and fees are invoiced in Ringgit Malaysia (RM) only.
2. An invoice will be issued by the school for all tuition and fees. Tuition and fees must be
paid by the due date listed on the invoice. After 15 days of non-payment (grace-
period), a five (5) percent per month compounded late payment charge will be applied
to the student’s account. After 30 days of non-payment, the school may withhold all
school records, and the school reserves the right to effect any appropriate actions
such as prohibition from attending classes, and/or de-enrollment of the student.
3. Payment may be made by a cheque drawn on a local bank and denominated in RM,
OR via direct bank transfer to the school’s bank account, OR by a cash deposit of RM
into the school’s bank account (providing the appropriate documentation is provided
the school office). Cash payments for tuition and fees will not be received at the TiS
Registrar’s office. Any bank or transaction charges incurred by the school from
payments other than according to the above instructions will be charged to the
student’s account.
4. Parents are responsible for the timely payment of school tuition and fees, even if the
tuition and fees are paid for by a third party or are reimbursable to the parent.
5. Refunds of the deposit sum paid to the school on admission will only be given on
receipt of a written request for refund with a minimum one terms’ (i.e. 4 months) notice
of de-enrollment of the student.
6. Parents are not permitted to engage a staff of the school to provide services to them or
their child (ex. tuition or training) without the prior written permission of The Principal. A
breach of this could lead to expulsion of any or all child/ren of the parent/s or guardian
concerned as well as disciplinary action being taken on the staff involved in any
potential conflict of interest situation.
7. The school reserves the right to disenroll a student at any time and/or for any reason
at it's sole and absolute discretion, and in such instance, will refund in full the balance
of the term fees (calculated on a pro rata basis) and the deposit sum less any
deductions.
By signing hereunder, I (we)
a) Certify that I (we) fully understand and agree to the financial obligations and
the terms and conditions of payment of tuition and fees resulting from
enrollment of my (our) child or children at TiS.
b) Choose the payment plan that I (we) will use to pay the tuition and fees due
to TiS.
It is mandatory that BOTH parents or legal guardians sign (unless in the case of a
single parent or legal guardian).

Parent/Guardian Signature: _______________________________ Date: __________________
Parent/Guardian Signature: _______________________________ Date: __________________

TiS MEDICAL INFORMATION FORM
Dear Parents,
A medical practitioner should fill out the following pages. When you visit your doctor please bring
with you any relevant documentation. Your child must have a full health and physical examination
either in your own country or in Malaysia within the first 30 days of entering TiS. If your child is
required to have a health and physical examination by your workplace and is deemed fit and
healthy for a posting in Malaysia, a photocopy of that documentation is acceptable.
Please note that a willful failure to disclose a known mental or other illness of a student applicant
(such as Autism, ADHD, Depression, Bipolar, Schizophrenia, Obsessive Compulsive Disorder,
Asperger’s, Downs Syndrome, Diabetes, AIDS or other communicable disease/s etc.) would be
grounds for removal of the student from the school rolls if admitted. The school reserves the right
to have an enrolled student medically examined by a medical specialist of its choice on the
parents/guardians account.
The school nurse will be responsible for the upkeep of all medical records. If there is a need to
discuss any concerns with the school nurse, please make an appointment or telephone as soon
as is possible. If your child has not already completed or commenced the REQUIRED
immunization series, then the following medical examination will be an opportunity to ensure this
is done. All documentation of updates and boosters should be sent to the nurse’s office.
The TiS policy on immunizations requires that your child has completed or commenced
the following series, within 30 days of entering TiS:
 Diphtheria (often but not always given as DTP, which includes diphtheria, tetanus and
pertussis)
 Tetanus (as above)
 Pertussis (as above)
 Measles (often but not always given as MMR, which includes measles, mumps and
rubella)
 Mumps (as above)
 Rubella (as above)
 Polio
 Chickenpox
 Influenza A (H1N1)
TiS strongly recommends that you speak with your family doctor about the
RECOMMENDED immunizations for living in Malaysia. Local international medical clinics
will recommend the following:
• Hepatitis A
• Hepatitis B*
• Japanese Encephalitis*
• Typhoid
• Rabies
• Tuberculosis** and Haemophilus influenzae Type b (Hib)***
These completed health forms should be filled out and sent to the school PRIOR to your

child start of schooling at Tanarata. However, if this is not possible, the school nurse
should receive them within 30 days of entering TiS.
* TiS strongly recommends

** SE Asia is one of the areas in the world with incidences of TB
*** Vaccine for meningitis; administration not necessary after 5 years of age

Physical Examination
Health Assessment for Enrollment at TiS
(to be filled out by a Medical Officer only)
Student Family Name: _______________________________
First Name(s): _______________________________
DOB: dd____ mm____ yy____
Sex: Male _ Female _
Allergies ____________________________________________________________________
Symptoms ___________________________________________________________________
Current Medications no _ yes _ ________________________________________________
Asthma no_ yes _ Asthma medication(s): ________________________________
Does this child carry Asthma medication to school? __________________________________
Diabetes no _ yes _ ______________________________________________
Epilepsy no _ yes _ ______________________________________________
Mental Illness / Disability no _ yes _ _____________________________________________
Note that willful failure to disclose a known mental or other illness of a student applicant (such as Autism,
ADHD, Depression, Bipolar, Schizophrenia, OCD, Aspersers’, Down’s Syndrome, Diabetes, AIDS or other
communicable disease/s etc.) would be grounds for removal of the student from the school rolls if admitted.
Medical History please print



Immunization Status Complete Next Due
Diphtheria yes/no
Tetanus yes/no
Pertussis yes/no
Measles yes/no
Mumps yes/no
Rubella yes/no
Polio yes/no
Chickenpox yes/no
H1N1 yes/no

General Appearance - physique
Mobility – note any restrictions Scoliosis yes _ no _
Height……………………cm Weight…………………kg
Eyes Glasses yes _ no _ If yes, used for reading? yes _ no _

Colour blind? yes _ no _ Left eye vision 20/….. Right eye vision 20/…….
……………………………………………………………………………………….
……………………………………………………………………………………….
Ears Nose Throat
Hearing (test only if hearing deficit suspected) 500 1000 2000 40000
Results of Audiogram:
Right Ear_______________________________
Left Ear _______________________________

frequency in Hertz, hearing level in decibels
Mouth / tongue Any speech problems?
Is abdominal examination normal?
Is respiratory system normal?
Skin - note eczema / dermatitis
Blood Group (NB *documentation required*): AO BO AB O RH+ RH-
Mantoux test Date last given………………. Result: positive _ negative _
BCG? no _ yes _ date given ……………………………………………….
Comments………………………………………………………………………………
…………………………………………………………………………………..……….

Has your child had naturally occurring
Chicken Pox yes _ no _
Measles yes _ no _
Mumps yes _ no _
Rubella yes _ no _

TiS RECOMMENDED IMMUNIZATIONS
FOR LIVING IN MALAYSIA
Vaccine Date Doctor or Clinic

signature or stamp
1
Hepatitis A
2
1
Hepatitis B 2
3
1
TYPHOID 2
(oral or injection) 3
4
1
HIB 2
(Haemophilus influenzae Type b) 3
4
1
Chicken Pox 2
3
I have completed the physical examination for (student name) ___________________
on (date) __________________ .
I have checked the immunization status of this prospective student and have discussed
with the parents a plan to complete any school required vaccinations.
In my opinion (student name) _______________________________________ is

deemed mentally and physically fit and healthy to enroll at TiS.
Signature of Examining Doctor______________________________________________
Medical Clinic Stamp/ Address details

EMERGENCY MEDICAL AUTHORIZATION
1. AUTHORIZATION FOR EMERGENCY TREATMENT:
This will authorize TiS to refer my child/children for treatment to a physician in the
event of an accident or sudden illness at a time when I cannot be reached or when
my emergency number cannot be reached. I shall bear financial responsibility for any
such treatment.
FAMILY NAME: __________________________________
NAME OF CHILD(REN) YEAR / GRADE
PARENT’S SIGNATURE:
___________________________ DATE: _______________
2. EMERGENCY CONTACTS:
Should the school be unable to contact us in the event of an emergency, we suggest

that one of the two people below be contacted.
NOTE: Emergency contacts should be reliable persons who are available and have transportation during your
child's class session. This must be someone your child knows well and who can be called upon in an emergency
to pick him/her up at school and care for the child.
1. ____________________________________ (Name in full)


- Home No.: ____________________
- Office No. ____________________
- Mobile No.:____________________
2. ____________________________________ (Name in full)

- Home No.: ____________________
- Office No. ____________________
- Mobile No.:____________________
3. FAMILY DOCTOR / MEDICAL PROVIDER IN MALAYSIA:
Our family doctor/medical provider in Kajang / Bangi, Putrajaya / Kuala Lumpur,

Malaysia is:
NAME: _________________________________________
ADDRESS: _________________________________________
PHONE NUMBER: _________________________________________

FIELD TRIP PERMISSION FORM
I hereby give permission for my child/children:
FAMILY NAME: __________________________________
NAME OF CHILD(REN) YEAR / GRADE

____________________________________ ______________
to leave the TiS Campus for field trips, P.E. or other activities within Kajang / Putrajaya,
Kuala Lumpur or surrounding areas under the following conditions:
 That all such activities are appropriately monitored and chaperoned by

school personnel.
 Parents are informed in advance of such activities via notes sent home
with students.
I agree not to hold the school, the sponsors of the activity or the chaperones responsible
for any accidents that might occur during the course of such events.
PARENT’S SIGNATURE: ________________________________
DATE: _____________________

TiS COMMUNICATION PROGRAMS
RELEASE CLEARANCE
I hereby provide consent to Tanarata International Schools (TiS), that my child/children

(indicated below) will be allowed to participate in TiS’s communication programs:
FAMILY NAME: __________________________________
NAME OF CHILD(REN) GRADE
____________________________________ _______________
____________________________________ _______________
____________________________________ ______________
The TiS communication programs are primarily aimed for promotional, publication,
educational, and motivational purposes. TiS communication programs may involve still-
images, text, videos or audio recordings of teachers, students, parents, and staff of TiS in
print, digital, and online media formats. Typically, no names or identification of the child
is applied unless justifiably warranted.
PARENT’S SIGNATURE: ________________________________
DATE: ____________________________

TiS Disclaimer & Release of Liability Statement
Tanarata International Schools (TiS) provides educational and physical development programs to
enrolled students at it's school campus facilities. This is a legally-binding release made by the
undersigned to Tanarata International Schools, for access and provision of the above educational
and physical development services.
This liability release statement grants permission from the undersigned that they and / or their
child(ren) are enabled to participate in any activity organized and undertaken by TiS such as
schooling, learning and physical development activities, field trips, and to receive emergency
medical care wherever appropriate and applicable, without assignment or claim of any form of
liability to TiS appointed officers, teachers, agents, employees, and volunteers.
In consideration of being permitted to enroll at TiS, and participate in TiS activities, including, but
not limited to field trips, observation, miscellaneous classroom activities, use of facilities, use of
premises, and equipment or participate in any way, the undersigned hereby agrees to the
following:-
 I grant permission for my child(ren) to attend and participate in activities, including, but not
limited to arts and crafts, games, physical movement and exercise, and other activities
associated to the TiS programs.
 I grant permission for my child to use all of the play equipment, including, but not limited to,
the indoor play rooms and outdoor equipment.
 I agree to indemnify, defend, and hold harmless Tanarata International Schools (TiS)
and/or agents of TiS or any entity hosting an official TiS function from any and all lawsuits,
damages, claims, judgments, losses, expenses or liability arising if my child is injured in
any way.

 I agree to indemnify, defend, and hold harmless TiS, its elected and appointed officers,
teachers, agents, employees, and volunteers from any and all lawsuits, damages, claims,
judgments, losses, liability or expenses arising out of personal injury or property damage to
myself, my child or my ward, which may be sustained while participating in any activity
organized, undertaken, supervised, or sponsored by TiS, including sports teams and
activities. By signing this form, I realize that any specific activity is potentially hazardous,
including possible injury, serious injury, or death.
 I grant permission to the leaders, teachers, agents, volunteers, or officers of TiS to take
whatever steps may be necessary to obtain medical care if warranted. If necessary, I grant
TiS and/or agents of TiS to call a physician, call an ambulance, or have the child taken to
an emergency facility.
 I also understand that I cannot depend or rely on TiS’s insurance arrangements to provide
coverage for myself or my child(ren) or for our properties in any activity or program
associated to TiS. I understand there are always risks in any activity and I am responsible
for myself, my children, and any visitors I bring to TiS functions, premises, or activities.
This includes any property that I or my children own.
 I further understand that if I am supposed to remain in the facility while my child is

participating in TiS functions or programs, I am responsible for representative attendance
on premises. If, for some reason, I cannot accompany my child to a TiS function, I
understand that I am responsible for appointing a caretaker for my child. TiS cannot take
responsibility for children left unsupervised at any activity, program or function that is not
organized, supervised, and managed by TiS.
 I agree that TiS has responsibility without liability for the care of my child and his/her
property while he/she is at TiS or participates in school sanctioned activities and functions.
I have read, understand, and agree with this RELEASE OF LIABILITY. I hereby declare, under
penalty of perjury, that I am the parent or legal guardian of the named student or participant(s).
Student’s Name (s)
______________________________________________________ Age ______
______________________________________________________ Age ______

______________________________________________________ Age ______
______________________________________________________ Age ______
Parent(s)/Guardian Signature:
______________________________________________ Date _________
______________________________________________ Date _________

TiS Student Enrollment Application Form - 2017-18

Hochgeladen von

Dokumentinformationen

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

TiS Student Enrollment Application Form - 2017-18

Hochgeladen von

Copyright:

Verfügbare Formate

TiS

You may mail them to: The Registrar

Tanarata International Schools 2

Tanarata International Schools

Tanarata International Schools

I take this opportunity to warmly welcome you to look at Tanarata International

Tanarata International Schools 4

Tanarata International Schools

ENROLLMENT CHECK LIST

 ENROLLMENT FORM (with 2 copies of photographs)

Admission Eligibility Requirements:

For Malaysians (if required to comply with Ministry of Education’s requirements):

Tanarata International Schools 5

Tanarata International Schools

FOR OFFICE USE ONLY

Tanarata International Schools 6

Tanarata International Schools

Personal Data Protection Regulations 2013

Tanarata International Schools

Tanarata International Schools 8

Tanarata International Schools

DATE OF BIRTH: ____________________

NATIONALITY: _________________ Race/Origin: __________________ Faith: ________________

1st LANGUAGE: ______________________________ Beginner

HOME ADDRESS (Malaysia):

TEL: _____________________ FAX: _______________________

CURRENT E-MAIL ADDRESS: ___________________________________________

REQUESTING PLACEMENT INTO CLASS YEAR / GRADE: _______________________ *

Tanarata International Schools 9

Tanarata International Schools

Tanarata International Schools 10

Tanarata International Schools

Tanarata International Schools 11

Tanarata International Schools

FATHER'S NAME AND TITLE / POSITION:

ORGANIZATION'S NAME & ADDRESS (in Malaysia and/or overseas):

E-MAIL ADDRESS: ___________________________________________

TEL: ___________________ MOBILE: ___________________ FAX: ____________________

Date of Birth: ________________

Nationality: __________________ Race: _________

Languages Spoken and degree of proficiency:

Degree / Diploma / Cert. Subject Specializations Year obtained University

Tanarata International Schools 12

Tanarata International Schools

Tanarata International Schools 13

Tanarata International Schools

ORGANIZATION'S NAME & ADDRESS (in Malaysia and/or overseas):

E-MAIL ADDRESS: ___________________________________________

TEL: ___________________ MOBILE: ____________________ FAX:

Date of Birth: ________________

Nationality: __________________ Race: _________

Languages Spoken and degree of proficiency:

Degree / Diploma / Cert. Subject Specializations Year obtained University

 Please attach Curriculum Vitae of Mother (required).

Tanarata International Schools 14

Tanarata International Schools

Tanarata International Schools 15

Tanarata International Schools

1) NAME, CITY, COUNTRY OF SCHOOL:

LANGUAGE OF INSTRUCTION: ____________________________________________

DATES ATTENDED: FROM: ____________________ TO: ______________________

NAME OF CLASS/GRADE ENROLLED:

AT ENTRY: __________________ ON LEAVING: _______________

2) NAME, CITY, COUNTRY OF SCHOOL:

NATIONALITY: _ Race/Origin: Faith: __

TEL: _ FAX: ___

TEL: _________ MOBILE: _ FAX: ____________

Nationality: __________ Race: _

TEL: _ MOBILE: __ FAX:

Nationality: __________ Race: _

DATES ATTENDED: FROM: TO: __

AT ENTRY: ____ ON LEAVING: _

DATES ATTENDED: FROM: TO: __

AT ENTRY: ____ ON LEAVING: _

_ Website _ Friend

_ Company _ Embassy

_ Last school _ International Directories

1. Employer (name) ____________________ Employer pays _

Parent/Guardian Signature: _____________ Date:

DOB: dd mm yy