INSCRIPTION FORM
                (to fill in, print, sign and send to the school's offices)          

 

• Information about the student  :

 

Surname:     Name:

Date of birth:   Place of birth :

Nationality(ies):  

• Information about the family :

The student lives with his family with his mother� with his father � with a tutor�
Home address :
Telephone :
E-mail:

 

Father Surname: Name : Address (if different than above) Profession : Company : Tel. professional  : Cell phone  : Mail :

Mother Surname: Name :  Address (if different than above) Profession : Company : Tél. professional  : Cell phone : Mail :

Do you agree to advise the rest of parents your information (telephones, e-mail)?    YES  NO�

Please advise us in case of any change, even though temporary.

Transport:           Morning:  school bus      parents�     chauffeur�
                              Afternoon :  school bus     parents�     chauffeur�

 Authorized Person(s) to pick up the child after classes

• SCHOOL INFORMATION REGARDING CHILD:

School year	Name of school	Class	City, Country

 

Languages spoken at home	By who  ?

The student understands French  :           Well               more or less �           not at all �
The student speaks French :             Well              more or less�            not at all  

Other useful information regarding their abilities, likings, and eventual difficulties of the student:

 

• INFORMATION ON CHILD’S HEALTH:

Applied vaccinations  :
Long-term treatments :
Particular allergies (food, medicines, insects)
Personal Physician Tel:
Person to contact in case of emergencies in the absence of parents (name, telephone):

 

AUTHORIZATION IN CASE OF EMERGENCY:

I, Mr./Mrs authorizes Paul Gauguin French High School to take the necessary measures
in case of emergency and to take my son/daughter

to an emergency hospital center the nearest recommended by the insurance company covering the school students.

 

Panama, the ................................................

 

 

Parent's signatures :

 

 

 

Lycée Français de Panama/Liceo Frances de Panamá/The French School of Panama 2008