STUDENT APPLICATION

Parry Learning Center is located nearby Bangkok Hospital, end of Thonglor Rd. 447

Soi Soonvijai New Petchaburi Rd. 47 Yaek 3 Bangkapi Huaykwang Bkk. 10310

Admissions: 085-026 -9966, 089-692-4248 E-mail:parrypie@gmail.com www.parryschool.com

Student

Date of Birth (D/M/Y)

Age

Gender

Place of Birth

Nationality

Country/Passport #

Issue Date

Expiry Date

Home Address

District/City/Zip

Home Phone

Level of English

...

Previous School Record (If more than one, please list most recent first)

Age Class Level Name of School City/ Country From To

Friendship Patterns


Favorite Activities

Siblings

(include age/birth date)

Health

Does your child have food allergy?

(if yes, please explain)

Does your child have physical needs or limitations of which the center should be aware

(if yes, please explain)

Has your child been seen by an Education Psychologist or received any kind of special help because of learning difficulties or social problems?

(if yes, please explain)

Family Doctor

Hospital

For Office Use Only


Date of Application

Grade

For Term

Assisted

Assessment Test

Results

Comment

Student Enrollment#

Accepted for Grade Level

Starting Term (Y/T)

Parent Information


Full Name
Nationality
Employer
Occupation
Office Address
Work Phone
Mobile Phone
E-mail
University/degree


Full Name
Nationality
Employer
Occupation
Office Address
Work Phone
Mobile Phone
E-mail
University/degree

Parent are

Incase of separation or divorce or if one parent is deceased

Are parent (s) remarried?

Child live with?

In case of Emergency, Contact ?

Who would be financially responsibility for the tuition and fees?

General Information

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