The document is an admission form for Colegio Internacional Puerto La Cruz, an accredited international school in Miami, Florida. It requests student information such as name, birthdate, citizenship, siblings, and contact information. It also requests parent/guardian information including name, citizenship, employer details, and contact information. Finally, it requests payment details, transportation preferences, educational background, emergency contacts, and parent signatures.

1. COLEGIO INTERNACIONAL
PUERTO LA CRUZ
MUN 6111,4440 NW 73rd Ave, Miami Fl. 33166
Phone (+58281) 277-6051 Fax (+58281) 2741134
Accredited by the Southern Association of Colleges and Schools
Admission Form
(Please type or print)
Student Information
Name
Last First Middle I.
Birth date / / Age Sex Applicant for Grade
M F
mm dd year
Passport/ID Number Citizenship
Arrival date / / Home Phone Fax
mm dd year
Siblings , ,
name age name age name age
Local Address
Current Address (If Different)
Parent/Guardian
Father’s Name
Citizenship
Company
Position
Work Address
Work Phone
Work Fax
E-mail
Mother’s Name
Citizenship
Company
Position
Work Address
Work Phone
Work Fax
E-mail
Tuition Fees Payment: Individual Corporate (Letter of responsibility required)
Are you interested in using school transportation services? YES NO
For Office use Admin Status A WL D Grade Assigned
First Day of School All Requirements Met: YES NO

2. COLEGIO INTERNACIONAL
PUERTO LA CRUZ
MUN 6111,4440 NW 73rd Ave, Miami Fl. 33166
Phone (+58281) 277-6051 Fax (+58281) 2741134
Accredited by the Southern Association of Colleges and Schools
Admission Form (Continued)
Educational Background
SCHOOL 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 Phone
Emergency Contact 2* ____________________________________________________
(*e.g. Cellular phone, family, friends, etc.) Name Phone
I UNDERSTANT THAT MY CHILD IS ACCEPTED CONDITIONALLY UNTIL THE
ADMISSION PROCESS HAS BEEN COMPLETED.
__________________ __________________ __________________
Father Signature Date Mother Signature
SUBMIT