Fillable APPLICATION FORM ACADEMIC YEAR OF ENTRY (please one)

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APPLICATION FORM ACADEMIC YEAR OF ENTRY (please one)

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ACADEMIC YEAR OF ENTRY (please one) TERM OF ENTRY (please one)
2019 - 20
2020 - 21
2021 - 22
2022 - 23
Term 1 (Aug)
Term 2 (Oct)
Term 3 (Jan)
Term 4 (Apr)
STUDENT PROFILE
PERSONAL DETAILS
Full Name
(as in passport)
Please underline the family name
At Nexus, students often have a name that they prefer to be called in class by their teachers. Also some have a family name that is dierent from that on their passports.
These alternative names are the ones that teachers recognise and call the student by and are used in lists and reports. They are also the names that make up the student’s
email address which is used across many systems as their unique username. For administrative reasons this does not change once they are enrolled and we would like you
to give some careful thought now about what you want them to be called by their teacher, and if you want them to use a dierent family name (surname). Please indicate
these in the spaces below (even if they are the same as on the passport) as it will help avoid confusion if we cannot identify the family and given names from the passport.
Example: Given Name: Xin; Family Name: Cai; Preferred Name: Jack; Preferred Family Name: Cai; School Email Address: jack.cai.27@nexus.edu.sg
Preferred Name
Preferred Family Name
Gender
Male
Female Date of Birth
Passport Number
Place of Birth
Passport Country
Nationality
Address in Singapore during term time (if known at the time of application, otherwise leave blank).
Postcode
Living with (during term time) Parents Guardian Hostel Alone
Current pass holder?
No Yes FIN/NRIC No.
Expiry Date
Pass type? (Please indicate the type of pass you have or the type you will be applying for)
Dependant’s Pass (DP)
Student’s Pass (STP)
Singapore (PR)
Diplomatic
Exemption Singapore (MOE)
Letter of Consent (LoC)
PREVIOUS SCHOOL BACKGROUND
(most recent at top)
NAME OF SCHOOL COUNTRY YEAR
/GRADE
DATES ATTENDED
(from/to)
LANGUAGE OF
INSTRUCTION*
WITH EXTRA
SUPPORT
CURRICULUM
(e.g. British, IBPYP etc)
Yes
No
Yes
No
Yes
No
*If not English, please submit details to Student Services of how and where English has been learnt.
ADDITIONAL ACADEMIC INFORMATION
Please answer ALL questions. Has your child ever: If yes to any of these questions, please give more detail.
Been advanced a year/grade or been retained?
No
Yes
Been in a gifted and talented or honours programme?
No
Yes
Been evaluated for a learning need/challenge?
No
Yes
Been the subject of a specialist report/intervention/assessment?
No
Yes
Received extra help/tuition during the school day?
No
Yes
Experienced social, emotional or behavioural diculties?
No
Yes
Had additional assessment support in a exam situation?
No
Extra time Scribe Word processor Separate invigilator
Please provide a copy of any reports/assessments with your application.
LANGUAGE INFORMATION
Is English your child’s first language?
Yes No
Other languages spoken at home
(in order of proficiency)
Foreign Language you would like your child to learn at school (please one) Mandarin French
If your child has studied this language previously, how many years experience does s/he have?
APPLICATION FORM
For Oce Use:
Pupil Code
dd/mm/yyyy
dd/mm/yyyy
EXPERIENCE STUDYING IN ENGLISH
Reset form
SIBLING INFORMATION
NAME SCHOOL ATTENDING DOB
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
CONTACT INFORMATION
You must provide a minimum of two contacts. The School must be notified of changes to these details as we must be able to
contact you in case of an emergency. If there are additional contacts please inform Student Services after enrolment.
Please list in order of priority (Contact 1 will be the emergency contact)
CONTACT 1 – From enrolment this contact must be resident in Singapore
Contact Name
(as shown in passport)
Please underline your family name
Relationship to the student
Gender
Male Female Title Mr Mrs Ms Dr Other
tick one only
Email
Type
Work Personal
tick one only
Singapore Mobile +65 Other Telephone + (
)
Mobile Landline
Residential Address
(if known at the time of application, otherwise leave blank)
Country
Postcode
tick if this is student’s term time address
Is this contact a fluent English speaker?
Yes
No If no, state the native language
Does this contact need a translator? Yes No
CONTACT 2
Contact Name
(as shown in passport)
Please underline your family name
Relationship to the student
Gender
Male Female Title Mr Mrs Ms Dr Other
tick one only
Email
Type
Work Personal
tick one only
Singapore Mobile +65 Other Telephone + (
)
Mobile Landline
Residential Address
Country
Postcode
tick if this is student’s term time address
Is this contact a fluent English speaker?
Yes
No If no, state the native language
Does this contact need a translator? Yes No
CONTACT 3
Contact Name
(as shown in passport)
Please underline your family name
Relationship to the student
Gender
Male Female Title Mr Mrs Ms Dr Other
tick one only
Email
Type
Work Personal
tick one only
Singapore Mobile +65 Other Telephone + (
)
Mobile Landline
Residential Address
Country
Postcode
tick if this is student’s term time address
Is this contact a fluent English speaker?
Yes
No If no, state the native language
Does this contact need a translator? Yes No
Which contact is responsible for signing the contract? (please one) Contact 1 Contact 2 Contact 3
Which contact is responsible for paying the fees?
Contact 1 Contact 2 Contact 3 Other
Tick one only. If a company is paying the fees please fill out a company payment form. If there is more than one fee payer please contact Student Services.
Are the parents living together? Yes No
Is there anything important that we need to know about family relationships or legal/custody arrangements?
SINGAPORE
WELLBEING
HEALTH HISTORY
Please provide details if your child suers from any of the following:
Asthma Epilepsy Diabetes
Heart Condition Hearing / Vision Deficit My child does not suer from any of these conditions
Other medical conditions
You may be contacted by our School Nurse or the Class Teacher if there are any specific requirements which need to be discussed,
such as access to medication during the school day.
IMMUNISATION & VACCINATION HISTORY
You are required to submit a copy of your child’s immunisation history/vaccination record together with this form.
ALLERGIES
Please list all triggers and reactions:
Does your child require an EpiPen? Yes No
Does your child require any other medication for their allergies?
(please list)
MEDICATION
Is your child on any regular medication?
Yes No
If Yes, please list the medication, dose and reason:
OTHER INFORMATION
HOW DID YOU HEAR ABOUT US?
Education Fair Relocation Company/HR Recommended by a friend Agent Referral
HAVE YOU SEEN A NEXUS ADVERT? Please Tick all that apply
Facebook/Instagram Online Bus MRT Magazine
Other; Please specify
:
WHY NEXUS?
Why did you choose Nexus?
Have you applied for a place in another international school in Singapore? Yes No
If Yes, which school/s?
What is the likely duration of your stay in Singapore?
CONTACT PERSON AT MOST RECENT SCHOOL ATTENDED
We may need to contact the child’s most recent school/kindergarten for reference or testing.
Please indicate whether the current school is aware of this possible move:
Yes No
Name
Position Telephone + (
)
School Name Email
The School reserves the right, and the parent hereby authorises the School, to contact the previous school, or such medical ocers or
other relevant persons, any for further information requiredrelating to the child in consideration of this application.
DOCUMENTS TO SUBMIT
(Please remember to include the following)
Previous School Reports Vaccination/Immunisation History Copy of Passports Learning Support Assessments
If applicable
CONSENT AGREEMENTS
MEDICAL ATTENTION
I consent for the School to provide first aid or treatment to my child/ward in case of medical emergency. If I cannot be contacted I authorise the School to act on my
behalf to arrange medical or surgical treatment as may be deemed necessary. I also undertake to pay any medical costs which may be incurred, including ambulance
transport and medication. I will not hold the school liable for any accident resulting from any erroneous / withheld medical information on this form and/or any other
information submitted. I will keep the school informed if my child/ward develops any medical condition. I consent for the school medical sta to administer:
Paracetamol
YES NO
Antihistamine YES NO
COUNSELLING
In the event that my child/ward requires counselling as deemed necessary by the School Counsellor, Head of School or Principal, I hereby give my consent.
I understand that the School Counsellor will inform my child/ward at or before the time the counselling relationship is entered into, the limits of confidentiality such
as the possible necessity for consulting with other professionals, privileged communication, and authoritative restraints. I also understand that the School will keep
information confidential within the safeguarding team unless disclosure is required to prevent clear and imminent danger to my child/ward, or others, or when legal
requirements demand that confidential information be revealed.
HEALTH & SAFETY IN AND OUT OF SCHOOL
I understand that in the regular course of on-site and o-site education organised by Nexus International School (Singapore) my child/ward will be involved in a variety
of sports and activities. I acknowledge that during these activities, my child/ward may be exposed to unforeseen circumstances and occurrences, including but not
limited to, illnesses, accidents, weather conditions, and other unusual events and situations. Nexus International School (Singapore) Sta will follow agreed protocols
and procedures to ensure the safety of all children during these classes, sports and activities. However, during such activities, accidents may happen. I agree that the
school or any teachers or ocials or voluntary helpers of the school, shall not be liable in respect of bodily injury to my child/ward unless the injury is caused by or
resulting from negligence of any employee, teacher or other person or persons authorised to act for or on behalf of the School.
PHOTOGRAPHY RELEASE
I hereby give my consent to the School to use photographs, images, recordings, works or derivative works of the child free of charge, in any media and for whatever purpose
as the School shall deem fit, including, without limitation, any promotional materials and the website of the School.
DECLARATIONS
PERSONAL DATA PROTECTION ACT, CONFIDENTIALITY & SECURITY POLICY
I understand that the School holds information about my child including, but not limited to, exam results, forecast results, parent contact, financial information and
details of medical conditions. I understand that the School processes information about my child in order to safeguard and promote the welfare of my child, promote
the objects and interests of the School and Taylor’s Education Group, facilitate the ecient operation of the School, and ensure that all relevant legal obligations of
the School are complied with. By signing this form, I, the parent/guardian, on behalf of my child/ward, authorize the School to process personal information including
financial and sensitive personal information, as is deemed necessary for the legitimate purposes of the School within Taylor’s Education Group.
FINANCIAL STANDING, REFUND & WITHDRAWAL
I confirm that all fees owed to previous schools have been paid in full and that I am not in dispute over fee payment with any school. I hereby authrorise Nexus
International School (Singapore) to confirm good financial standing with previous schools listed on this form. The most up-to-date Refund Policy and Withdrawal Policy
can be found on the School’s website.
SAFEGUARDING
Nexus is committed to providing a safe environment for all members of our community. Safeguarding and promoting the welfare of our learners is paramount to us.
Nexus reserves the right to contact the learner’s previous school and ask them to provide details of any safeguarding or welfare concerns we should be aware of.
CRIMINAL RECORD DISCLOSURE
If any of the contacts listed in this form have ever been convicted in a Court of Law in any country, are currently involved in any ongoing legal proceedings, or have ever
been detained by the police, military police, CID, CPIB or any other government law enforcement agency, please disclose this now:
YES NO
If you ticked yes the school will contact you for further information. All information you provide will be treated as confidential and managed in accordance with relevant
data protection legislation and guidance.
DECLARATION BY PARENT/GUARDIAN (please delete as appropriate)
I have read, understood and agree to the above admission requirements, all sections of this form, and permission declarations contained herein. I understand that this
form is part of the documentation required for admission to Nexus International School (Singapore). All documents required to be submitted with this application are
attached. For required documents not attached, I/we undertake to furnish such documents by the date specified by the School, failing which the admission may be
subject to cancellation. This form must be completed and signed before the student can be considered for admission to the School.
I, the parent/guardian, confirm that all the information set out in this application is true and accurate at the time of completion. The school reserves the right to vary or
reverse any decision regarding the student’s admission or enrolment made on the basis of incomplete, untrue or inaccurate information.
Name of Parent/Guardian (please delete as appropriate) Signature Date
PLEASE USE BLOCK CAPS
dd/mm/yyyy
NEXUS INTERNATIONAL SCHOOL SINGAPORE, 201 ULU PANDAN ROAD, SINGAPORE 596468, T +65 6536 6566
Version 5.2 @ October 2019
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APPLICATION FORM ACADEMIC YEAR OF ENTRY (please one)

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Completed 26 April 2021

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