ASSESSMENT FORM 2015 - 2016 RAJAGIRI International School LLC POBOX: 62012, Al-Warqaa 1, Dubai, UAE. Email: admissions@risdubai.org, Web: www.risdubai.org T: 04-2800691, F: 04-2800692 Please bring along all the required documents mentioned on the website Admission no:……….……………………... Date:….…...….……….. Name of the child:…………..…………………………………………………………………...... Date of Birth:……………………………………………………………………………………… Grade to which admission is sought:…………..………………………………………………… Siblings in RIS : ………….………………………………………………………………………. Grade & Section of siblings: …………………………………….……………………………… Name & address of parents:……………….………………………………………………………. …………………………………………………………………………..………………………..... Phone numbers:…………………………….……………………………………………………… Email :……………………………………………………………………………………………... Assessment Fees: DHS 50 FOR OFFICE USE ONLY REGISTRAR:………………………………………………………………………….………….. CLINIC:………………………………………………………………………………………….. COUNSELLOR:………………………………………………………………………………....... ......................................................................................................................................................... …………………………………………………………………………………………………….. SUPERVISOR:…………………………………………………………………………………… …………………………………………………………………………………………………….. ……………………………………………………………………………………………………. PRINCIPAL:……………………………………………………………………………………… ACCOUNTS:……………………………………………………………………………………… Page 1 REGISTRATION FORM 1 RAJAGIRI International School LLC POBOX: 62012, Al-Warqaa 1, Dubai, UAE. Email: admissions@risdubai.org, Web: www.risdubai.org T: 04-2800691, F: 04-2800692 Admission to Grade: ………………………. PHOTOGRAPH Academic Year:………….…………………. Date of Admission: ………………………… Admission No: …..…………………………. Name of the child (as in the passport)……………………………………………………………... Gender: Male Female Religion:……………………………………… Second language: Hindi French Malayalam Date of Birth:………………………………… Place of Birth (city / state):………………... Country:……………………………………… Nationality:………………………………... Passport Number:……………………………. Issued at:………………………………….. Date of Issue:…………………………………. Date of Expiry:……………………………... Visa Number:………………………Date of Issue:……………….Date of Expiry:……………………. Emirates ID No……………………….……Date of Issue:…………….Date of Expiry:………………. Parents / Guardian’s Name:……………………………………………………………………………… Mobile No:…………………………………… Email:……………………………………….. LOCAL ADDRESS P.O.B ox:……………………………………… Emirate:……………………………………... Residential Address (area):………………………………………………………………………………. Telephone Numbers: Residence:………………....Office:……………………Mob:…………..………. Page 2 REGISTRATION FORM 2 DETAILS OF CHILD’S PERFORMANCE Name of the school last attended:………………………………………………………………………... Grade:…………………………………… Syllabus followed: ISC CBSE Special extra-curricular of the child: Second language at school:…………………………. O-LEVEL Sports Others (Please specify):…………………… Music Drama Art Has your child participated in any ‘Inter-school / Inter- House’ activities? Elocution Dance Yes No If yes, please give the details:……………………………………………………………………………. Does your child need special medical care? Yes No If yes, please give the details:……………………………………………………………………………. Does your child have any learning disability? Yes No If yes, please give the details:……………………………………………………………………………. 1. Duly attested TRANSFER CERTIFICATE will be submitted by me on or before …………… 2. ………………………………… will be submitted by me on or before…………………………. 3. ………………………………… will be submitted by me on or before…………………………. 4. ………………………………… will be submitted by me on or before…………………………. I …………………………………………….. Father / Guardian of ……………..……………………… do declare and verify that the above details given by me are correct. If found incorrect, registration may be rejected.  I fully understand that the school on accepting the registration of the son / daughter is not in anyway bound to grant admission, as the admission is purely based on the condition mentioned above.  I have fully understood the rules and regulations of the school and accept my responsibility to see that my son / daughter shall unquestionably abide by the decision of the Principal / Management and render all co-operation to the school.  I undertake that the school will not be HELD RESPONSIBLE for the admission of my son / daughter if cancelled by the concerned Ministry, and I shall not claim any refund of fees paid by me whatsoever. At registration one month tuition + registration + admission + activity fees must be paid. (non refundable). School fees are paid in 10 PDC cheques. If no PDC cheques, one extra month fees must be collected; it will be adjusted on the last month fees of school year. If the monthly fees is not received during the month, a 3 time warning will be forwarded with a gap of 3 days per warning. There after the student will be suspended as per KHDA regulations. Would you like to have co-education in RIS from Grade 5 onwards? Parent / Guardian Signature :……………………………. YES NO Date:………………………… Page 3 REGISTRATION FORM 3 RAJAGIRI International School LLC POBOX: 62012, Al-Warqaa 1, Dubai, UAE. Email: admissions@risdubai.org, Web: www.risdubai.org T: 04-2800691, F: 04-2800692 STUDENT DETAILS: Name of student: …………………………………………………………………………………. Grade: ………… Section: ………….. Date of admission (to Nationality: …………………………. Religion: be filled by office): …..………….... ..………………………………………… Second language: …………………… PARENT’S INFORMATION FATHER Name(as in passport) ……………………… Nationality:……………………………….. Occupation : …………………………….… Employer: ………………………….……. Mobile No: ………………………………… Office Tel No: …………………………… Email: ……….…………………………….. PO Box: ………………………….……… MOTHER Name(as in passport) : ……………………… Nationality: ……………………………… Occupation : ………………………………… Employer: ………………………….……. Mobile No: ………………………………… Office Tel No: ..………………….……… Email: ………………………………….…… PO Box: ………………………….…..….. Residence Address: ……………………………………………………………………………. Emirate: ……………………………………… Area (for Dubai Residents):………………. Residence Tel No:……………………………. Name & Address of local relative / Friend (to contact in case of emergency) : Name:………………………………………… Relationship to Child: …………………….. Mobile No1: ………………………………… Mobile No2: …………………….………… TRANSPORTATION DETAILS: (to be filled up after acceptance) Pick-up point: ………………………………… Pick-up Time: …………………….………. Drop-off point: ……………………………… Drop-off Time: ……………………………. ………………………………… Driver: …………………………………….. Bus No: Nanny: ………………………………………... Page 4 TRANSPORT FORM RAJAGIRI International School LLC POBOX: 62012, Al-Warqaa 1, Dubai, UAE. Email: admissions@risdubai.org, Web: www.risdubai.org T: 04-2800691, F: 04-2800692 My Son / Daughter ………………………………….…………of Grade……………………….. Section …………………………………………………..… will be availing the following facility: Transport Yes No (If yes, kindly fill the following) Pick-up point:…………………………………………………………………………...................... ……………………………………………………………………………………………………..... Drop off Point: ……………………………………………………………………………………… ……………………………………………………………………………………………………… Landmark:…………………………………………………………………………………………... ………………………………………………………………………………………………………. Telephone Numbers: Residence:……..………. Office :……………….. Mobile:………………… Any other Instruction:………………………………………………………………………………. ………………………………………………………………………………………………………. Parent’s Signature:………………………….. Accountant’s Signature:…………………….. Date:………………...………………. Date:………………………………… FOR OFFICE USE ONLY Transport (w. e. f):…………………………… Route:…………………………….… Bus Number:………………………………..... Name of the Driver:……………………..…… Admin Officer’s Signature: ……………… ….. Bus No. :………………………………………. Driver:………………………………. Route:……………………………………………………………………………………………….. Pick-up point:……………………………………………………………………………………….. Transport Supervisor’s Signature:…………………………………………………………………... Page 5 RAJAGIRI International School LLC POBOX: 62012, Al-Warqaa 1, Dubai, UAE. Email: admissions@risdubai.org, Web: www.risdubai.org T: 04-2800691, F: 04-2800692 NAME OF THE CHILD: …………………………………………………..... DATE: …………………………… DATE OF BIRTH: …………………………………………………………… CLASS: ………………………….. INSTRUCTIONS: kindly mark “√” to the following statements with reference to your child SLNO GROSS MOTOR 1 Climbs well 2 Walks down stairs alone, placing both feet on each step 3 Swings leg to kick ball 4 Runs easily 5 6 Bends over easily without falling Walks up stairs alternating feet with support FINE MOTOR 2 Makes vertical, horizontal, circular strokes with pencil or crayon.(scribbles) Turns book pages one at a time 3 4 Holds a pencil in writing position Button and unbutton easily 5 Turns rotating handles (door knob) 1 LANGUAGE 1 2 Uses pronouns (I, you, me, we, they) Recognizes and identifies almost all common objects and pictures 3 Can say name and gender 4 Uses words to communicate wants and needs 5 Knows simple rhymes and songs 6 7 Strangers can understand most of words Communicate effectively with age adequate vocabulary 8 Answers to simple questions COGNITIVE 1 Matches an object to a picture in a book 2 Plays make-believe with dolls, animals, and people 3 Waits for his turn 4 Sorts similar looking objects 5 Listens to stories 6 Knows several or any body parts 7 Understands concept of “two “and “one” PERFECTLY SLIGHTLY DIFFICULT DIFFICULT RAJAGIRI International School LLC POBOX: 62012, Al-Warqaa 1, Dubai, UAE. Email: admissions@risdubai.org, Web: www.risdubai.org T: 04-2800691, F: 04-2800692 SLNO 1 2 3 4 5 6 SOCIAL/EMOTIONAL Interacts with peers comfortably Expresses needs or thoughts clearly Expresses a wide range of emotions Engages in cooperative play Begins to follow simple rules Shows affection to whom they like PERFECTLY SLIGHTLY DIFFICULT DIFFICULT