Re-Enrollment Application

RE-ENROLLMENT APPLICATION

Applicant General Information

Student Name:


First	Middle	Last

Date of Birth:

Month/Day/Year

Address:


Street	City	State	Zip Code

Contact Numbers:


Home	Work	Cell	Email

Last Grade Level Completed:

**Placement will be based on Report Cards, Entrance Tests and/or Performance.**

Emergency Contact Person:


Name	Phone

For Filing of Proper Documents:

Parent	Guardian	Extended Family Members
Student Resides with (check applicable)

General Health Evaluation

Please answer the following questions in regards to your child’s health by circling Yes or No. Please note any additional medical concerns (i.e. medications, devices, important past medical history) or any other special provisions in the space provided.

1. Does your child regularly use any over the counter or prescribed medication?	Yes No
2. Does your child require a medical device while in school?	Yes No
3. Is your child required to wear corrective lenses (eyeglasses and/or contacts)?	Yes No
4. Please indicate which medicines BIS may dispense for minor discomfort:
Aspirin Yes No Tylenol Yes No Pepto Bismo Yes No No Medicines to Be Dispensed

Additional Information:


Allergies	Severity	Treatment

Transportation Information

*Please provide the following information to help BIS implement a more effective security plan. ID# will be given out and must be in the lower left-hand corner of the vehicle registered below. List times buses or drivers that should be picking up your child (morning, evening or both; or if there are specific days for different drivers or buses).

Name of Driver(s) or Bus Company	License Plate and/or Bus Number	ID#	Describe any special time schedule
		Office Use
		Office Use

Financial Information

Tuition: (Please select the following method of payment.) Please Note: Tuition payment will no longer be accepted at the Business Office.

Monthly Automatic Debit Withdrawal from your current banking institution. (Fees may apply)
Direct Billing ITAU Billing Services (Monthly bill sent to home address to be paid at bank only)

*Late Fees will be charged via ITAU Billing Services at a Rate of 5% of Monthly Rate. Payments can be made at any banking institution up until due date. After the due date, payments must be made at a ITAU branch. Tuition Payments will now be billed over a period of 12 months; however, if the student withdraws early, the last bill will contain the remaining Tuition Due for the year.

School Improvement Fee (formerly the Capital Fund fee): (Please select the following method of payment for this ONE time fee– PER STUDENT.)

1. Payment in Full to the Business Office.
2. Four Payments of R$5000. Set up through ITAU Billing Services and will appear on monthly tuition bill.
3. Twelve Payments of R$1667. Set up through ITAU Billing Services and will appear on monthly tuition bill.

Please indicate the FOUR specific months you wish to be billed for the School Improvement Fee. The months selected may not be altered as per the electronic billing process.

AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY

This is NOT an Optional Fee. If the full amount has not been met by the end of the first school year, then the balance will be billed with the last May tuition payment for the stated year.
.

Administration Fee: (now combined with the Application Fee, and Book/Supply List)
*Charge will be added to your first month’s tuition payment.

Registration Fee:
*Charge to be paid at BIS Business Office at the time Re-Enrollment Application is Submitted

Hot Lunch:
*Punch Cards are purchased at BIS Business Office. Purchased at the time of Re-Enrollment or before the first day of classes.

I, hereby, have been adequately informed and accept all the appropriate responsibilities as a client of Brasilia International School. This includes, but is not limited to, finances and the code of conduct put forth by Brasilia International School.

Parent’s Name:

Date: CNPJ# CPF#

Brasilia International School admits and cares for students without regard to race, color, physical handicap, or ethnic origin.

Brasília International School
SGAS 914 Conjunto C Lotes 67/68 Asa Sul – Brasília – DF 70390-140
Phone: (55) (61) 3346-1200 - (55) (61) 9147 3539 Fax: (55) (61) 3346-1500