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Admision form

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CIPLC School Admissions Form to be filled out by parent.

CIPLC School Admissions Form to be filled out by parent.

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  • 1. COLEGIO INTERNACIONAL PUERTO LA CRUZ MUN 6111,4440 NW 73rd Ave, Miami Fl. 33166 Phone (+58281) 277-6051 Fax (+58281) 2741134 Admission Form(Please type or print) Student InformationName Last First Middle I.Birth date / / Age Sex M F Applicant for Grade mm dd yearPassport/ID Number CitizenshipArrival date / / Home Phone Fax mm dd yearSiblings , , name age name age name ageLocal AddressCurrent Address (If Different) Parent/Guardian Father’s Name Mother’s Name Citizenship Citizenship Company Company Position Position Work Address Work Address Work Phone Work Phone Work Fax Work Fax E-mail E-mailTuition Fees Payment: Individual Corporate (Letter of responsibility required)Are you interested in using school transportation services? YES NOFor Office use Admin Status A WL D Grade AssignedFirst Day of School All Requirements Met: YES NO Accredited by the Southern Association of Colleges and Schools
  • 2. COLEGIO INTERNACIONAL PUERTO LA CRUZ MUN 6111,4440 NW 73rd Ave, Miami Fl. 33166 Phone (+58281) 277-6051 Fax (+58281) 2741134Admission Form (Continued) Educational BackgroundSCHOOL ATTENDED (most recent in line 1)1.- Name of School Address ___________________________________________________________________________________________ Phone _______________Fax ________________E-mail______________________ Attendance Dates From ___________To _______________Grade_______________2.- Name of School Address ___________________________________________________________________________________________ Phone _______________Fax ________________E-mail______________________ Attendance Dates From ___________To _______________Grade_______________Special Programs (Special Ed., Gifted/Talented, ESL, etc.) _____________________________________________________________________________________________ ______________________________________________________Emergency Contact 1* ____________________________________________________ Name PhoneEmergency Contact 2* ____________________________________________________(*e.g. Cellular phone, family, friends, etc.) Name PhoneI UNDERSTANT THAT MY CHILD IS ACCEPTED CONDITIONALLY UNTIL THEADMISSION PROCESS HAS BEEN COMPLETED.__________________ __________________ __________________ Father Signature Date Mother Signature SUBMIT Accredited by the Southern Association of Colleges and Schools