APPLICATION FORM - Sites - Anglo-Chinese School

Room No.Anglo - Chinese School(Independent)Boarding SchoolPHOTOL/No.* Delete Accordingly APPLICATION FORM GST REGISTRATION NO: MB-8100009-8NamePERSONALPARTICULARSOF PUPILNRIC/FIN No.Date ofBirthClassNationality Race ReligionEmail AddressHP#Name*DR/MR/MRS/MDM/MISSContact No.PARTICULARSOF PARENTAddress (in English)1.2Email AddressRelationshipHP#OccupationName*DR/MR/MRS/MDM/MISSPARTICULARSOF LOCALGUARDIANAddress1.2Contact No.RelationshipOccupationAre you on anyscholarship?YesNoIf yes, name & typeof Scholarship :Name of Primary/Sec School CCA Level of participationMedical BackgroundIf you have any pre-existing illness, please state the illness, the current treatment and the physician treating it, ifany.If you are allergic to any substance, food or medicine, please list :Continued next page………Page 1 of 2Revised in Dec 2011/ Printed on 29.11.2011

I ………………………………… would like to register my son/ward, …………………………..for the ACS (I)Boarding School. I understand that all Boarding School activities will be carried out with the necessaryprecautions and that neither the School nor its staff may be held responsible for any accident or injury. I havealso indicated any known pre-existing illness or allergies to medicines or substances in this application form.I undertake to pay fully all Boarding School Fees within 1 week of the collection of room key.Please tick against the relevant category:FEES PAYABLE BY SEMESTERHall 1 to 14ACS (I) Pupil (Local) $3,700ACS (I) Pupil (SPR) $4,440ACS (I) Pupil (Foreign) $5,000NOTE:Additional fees for vacation stay during May, Jun, Nov and Dec will be charged at the following rates:-ACS (I) Pupil (Local)ACS (I) Pupil (SPR)ACS (I) Pupil (Foreign)Hall 1 to 14$185 per week$222 per week$250 per week(All fees quoted are inclusive of GST)I enclosed herewith * CASH/CHEQUE $200.00 (deductible from 1st payment) as a non-refundable down paymentfee. Please pay in full if stay is less than 1 month away. Cheques should be made payable to: ACS (I) BoardingSchool. Please note that all fees paid are non-transferable & non-refundable.………………………………………………………….Name/Signature…………………………………..DateDateRoom No.LaundryNo.Signatureon date ofcollection ofkeyDateRoom No.LaundryNo.Signatureon date ofcollection ofkeyDate Receipt No. Details Amount/$ Date Receipt No. Details Amount/$Page 2 of 2Revised in Dec 2011/ Printed on 29.11.2011