General Enrollment Form and Permissions


Student #1










 
Diversity Information
Why are we asking this? Diversity, including ethnic diversity, is a core value of EBIGS. We use this information to monitor our achievement of this goal. We are also often asked to report this data to grantors and accreditation agencies.  We only report aggregate statistics and never identify individuals.


 








List any medical conditions requiring special attention:







 
Student #2










 
Diversity Information
Why are we asking this? Diversity, including ethnic diversity, is a core value of EBIGS. We use this information to monitor our achievement of this goal. We are also often asked to report this data to grantors and accreditation agencies.  We only report aggregate statistics and never identify individuals.


 








List any medical conditions requiring special attention:







 
Student #3










 
Diversity Information
Why are we asking this? Diversity, including ethnic diversity, is a core value of EBIGS. We use this information to monitor our achievement of this goal. We are also often asked to report this data to grantors and accreditation agencies.  We only report aggregate statistics and never identify individuals.


 








List any medical conditions requiring special attention:







 
Student #4










 
Diversity Information
Why are we asking this? Diversity, including ethnic diversity, is a core value of EBIGS. We use this information to monitor our achievement of this goal. We are also often asked to report this data to grantors and accreditation agencies.  We only report aggregate statistics and never identify individuals.


 








List any medical conditions requiring special attention:







 
Parent/Guardian

 















 















Pick-Up Authorization
I authorize the following adults to pick up my child from school:


Emergency Contact Information
Best phone number to call in the event of an emergency:


In case of a major earthquake or similar emergency, students are not permitted to leave school premises unless accompanied by a parent or other authorized adult. In the event of an emergency, I authorize the following adults to pick up my child from school:


Authorization for Emergency Medical Treatment

understand that my/our child may need emergency treatment while attending programs operated by the East Bay German International School (the “School”). I/we hereby authorize the School, through its employees and agents, to administer such first aid or other minor medical treatment as is deemed best under the circumstances.

I understand that the School will attempt to notify me in the event of an emergency requiring immediate medical care for my child and if it is unable to notify me, it will have my child treated by a duly qualified physician at the nearest hospital or emergency center. Any medical information provided to the School may be shared with emergency medical personnel. This authorization applies to all school-sponsored programs. I authorize the School, through its employees and agents, to consent to necessary medical or dental care including but not limited to X-ray examination, anesthesia, medical or surgical diagnosis, treatment and/or hospital care to be rendered upon the advice of any licensed physician and/or dentist.

This authorization shall remain effective until revoked in a writing delivered to the School. I/we understand that the School and its agents shall have no liability of any kind in relation to emergency treatment or transportation of the student. I/we further understand that all costs of paramedic transportation, hospitalization and any examination, X-ray, or treatment provided in relation to this authorization shall be my/our sole responsibility as the student’s parent(s)/guardian(s).
Permission to Apply Sunscreen
As the parent/guardian of the above child, I recognize that too much exposure to UV rays may increase my child’s risk of getting skin cancer someday. Therefore, I give permission for the staff at EBGIS to apply a sunscreen product that is broad spectrum with SPF 15 or higher to my child, as specified below, when she/he will be playing outside, especially during the months of March through October and between the daily time of 10 am and 4 pm. I understand that sunscreen may be applied to exposed skin, including but not limited to the face (except for eyelids), top of ears, nose, bare shoulders, arms, and legs.ext




Other Permissions



Media Release

Signature

By typing your name below and submitting this form, you confirm that the information provided in this form is accurate and complete and that you authorize the administration of emergency medical treatment and give the permissions as described above.







Contact Information