APPLICATION FORM STUDENT INFORMATION (Please write in capital letters!)
First Name(s) (please underline name used)
GUARDIAN(S) INFORMATION Guardian 1 Guardian 2
Please tick if you are the child’s only guardian
Square d'Argenteuil 5, B-1410 Waterloo, Belgium
STUDENT INFORMATION
Has the student had any type of learning support previously? Yes No Specific information which is important for the student’s education: special needs, medication etc. The student has studied French:
The student has brothers/sisters at BIS:
How did you get information about our school? From current School From a friend Advertising Website Other:…………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………
IMPORTANT INFORMATION BEFORE YOU DO YOUR APPLICATION! Please enclose the following with the application: To be provided by the current school:
Letter of motivation (in English) explaining why you
Scandinavian School of Brussels
Square d'Argenteuil 5, B-1410 Waterloo, Belgium
RULES OF PAYMENTS:
The annual fee for the coming school year is set in May at SSB’s general assembly.
A registration fee of 650€ is a one-time fee to be paid at the time of application for each new student at SSB. This fee will not be repaid if the student does not decide to attend the school. However, if the school cannot offer a place for the student, the fee is repaid.
The school fee is for a full school year. The fee is divided in to two different payments: 60% for payment at the latest June 15 and 40% for payment at the latest November 15.
New students pay their fees, at the latest, 10 days before they start. Students who begin at SSB after the start of the school year are given a reduction according to the following principles: Students who begin after November 1 pay 85%, after January 1 pay 60%, and after March 1 pay 45% of the yearly fee.
Students who leave the school during the school year should, in order to earn a reduced fee, inform the school of their intentions before the school year starts. Students who leave after November 1 or April 1 will not be given a reduction.
Students who have not paid their fees according to the rules above have no right to start at the school.
The school uses interest fees for past overdue payments. If the school is forced to follow-up the overdue payments, the parents must bear the costs incurred.
Invoices will be paid (please cross one)
The signature(s) below indicates that you accept the rules above and agree to the responsibility of payment of fees and agree to keep SSB updated of all changes in the contact details.
Square d'Argenteuil 5, B-1410 Waterloo, Belgium
ADMINISTRATION (For administration only)
Square d'Argenteuil 5, B-1410 Waterloo, Belgium
HEALTH RECORD THIS INFORMATION WILL BE KEPT CONFIDENTIAL Surname of student: ____________________________
Sex: ________ Grade: ______________________________
First / middle name: ____________________________
Date of birth: _____/______/__________________________ (Day) (Month) (Year)
Address:______________________________________
Email:____________________________________________
GSM Number mother: ___________________________
Office number: _____________________________________
GSM number father: ____________________________
Office number: _____________________________________
Family doctor (Belgium):_________________________
Tel.number:________________________________________
Family dentist (Belgium):_________________________
Tel. number: _______________________________________
IMMUNIZATION HISTORYFILL IN DATES GIVENREMARKS: Diphtheria/ Pertussis/ Tetanus
Last physical check: ____________________________
Last hearing test:__________________________________
Result: _______________________________________
Last vision test: ____________ Result: ________________
Colorblind: ____________________________________
Does your child wear glasses/contact lenses? YES / NO
Serious injuries: ________________________________________________________________________________________ Does your child have sport limitations: YES / NO Specify: _______________________________________________________ Has your child had surgery: YES / NO Specify: ________________________________________________________________ Hospitalizations: ________________________________________________________________________________________ Specify: _______________________________________________________________________________________________ Has your family members had any serious illnesses? Father: _______________________________________________________________________________________________ Mother: _______________________________________________________________________________________________ Brothers or Sisters: ______________________________________________________________________________________
Square d'Argenteuil 5, B-1410 Waterloo, Belgium
Has your child had, or been recommended to have: a) Speech therapy: ______________________________________________________________________________________ b) Psychological counseling: ______________________________________________________________________________ Do you have any other information you feel should be made known to the school in the interest of the child: Specify________________________________________________________________________________________________ HEALTH/ CHILDHOOD HISTORY: Concussion Headaches /Dizziness/Fainting Epilepsy Asthma / Eczema/ Hay fever Allergies Medical allergies Diabetes Heart problems / murmur Rheumatic fever Bone / joint injury Chronic illness or condition Ear tubes/ENT problems Tonsillectomy Adenoidectomy Sleep problems: Nightmares, bedwetting Chickenpox Scarlet fever Whooping cough Eating disorders CURRENT MEDICATION:
I give permission to administer, if necessary,PARACETHAMOL / IBUPROFEN / COLD MEDICIN YES / NO IF YES; PLEASE SIGN HERE: ____________________________________________________________________________ (Parent/Guardian) All prescription medications need a written note from parents/guardian. All Medications must be submitted to the form teacher or the school nurse. Medications must be in original containers, marked with name, dose and if needed instructions.
I approve that my child may be given Emergency Medical treatment if required. Date: ____________________________Signature:____________________________________________________________ IN CASE OF ACCIDENT OR ILLNESS- if parents cannot be reached, PLEASE NOTIFY:
Proceedings 2003 2003 SUSTAINABLE DEVELOPMENT OF ENERGY, WATER AND ENVIRONMENT SYSTEMS Table Content: Chapter 1 : Sustainability Science Analythical Hierarchy Process (AHP) in Decision – Making for End-of-Life of Products Aurora Dimache*, Galway Mayo Institute of Technology, Ireland Laurentiu Dimache, Galway Mayo Institute of Technology, Ireland Kate Goggin, Galway Mayo Institute
The CPN liaison service To provide a seamless mental health cases who, however, continue to be referred to service across the primary / secondary care CMHTs by GPs who feel that they do not have thenecessary expertise. Thus, there is a risk that some interface, it is necessary to look at the patients might find that neither primary nor needs of modern primary care and secondary care
APPLICATION FORM 
STUDENT INFORMATION 
RULES OF PAYMENTS: 
ADMINISTRATION (For administration only) 
HEALTH RECORD 
