Application Form - Crofton House School

#Office Use OnlyEnrolment Application for: September 20 ______ Grade: ______Student InformationLast NameMiddle NameDate of Birth (MM/DD/YYYY)Country of CitizenshipLanguage of Instruction at SchoolFirst NamePreferred NameCountry of BirthStudent’s First LanguagePrincipal Language Spoken at HomeAdditional Student InformationPlease indicate how you came to know about Crofton House School.Word of Mouth Sibling Connection Live in AreaAlumnae Connection Reputation Other: _______________________________________________Advertisment Website Referred by: __________________________________________Please indicate any previous enrolments at Crofton House School.Year(s): ________ Grade(s): ________Please indicate any previous applications to Crofton House School.Year(s): ________ Grade(s): ________Please attach a current photo of the applicant to the right.School Presently AttendingPresent SchoolPresent Grade LevelSpecialized Program (eg. Gifted, IEP)Street AddressCity Province Postal CodeCountry Telephone FaxFormer SchoolsSchool NameSchool NameDates Attended (mm/yyyy to mm/yyyy)Dates Attended (mm/yyyy to mm/yyyy)

Household 1 InformationAddressee (eg. Mr. & Mrs. John Doe)Salutation (eg. Mr. & Mrs. Doe)Street AddressCity Province Postal CodeCountryHome TelephonePlease send all Crofton House School correspondence to this address.Household 1 - Parent/Guardian 1Relationship to Applicant (eg. Mother, Father, Aunt, Guardian, etc.)First NameLast NameTitle (eg. Mr., Mrs.)Business Phone Cell EmailOccupationEmployerEmployer’s AddressParent Status Canadian Citizen and Resident of BC Landed Immigrant NOT residing in BCCanadian Citizen NOT residing in BC NOT Canadian Citizen and NOT Landed ImmigrantLanded Immigrant and Resident of BCHousehold 1 - Parent/Guardian 2 (if applicable)Relationship to Applicant (eg. Mother, Father, Aunt, Guardian, etc.)First NameLast NameTitle (eg. Mr., Mrs.)Business Phone Cell EmailOccupationEmployerEmployer’s AddressParent Status Canadian Citizen and Resident of BC Landed Immigrant NOT residing in BCCanadian Citizen NOT residing in BC NOT Canadian Citizen and NOT Landed ImmigrantLanded Immigrant and Resident of BC

Household 2 Information (if applicable)This section may not be applicable. If your child does not have a second household, please do not fill out this section.Addressee (eg. Mr. & Mrs. John Doe)Salutation (eg. Mr. & Mrs. Doe)Street AddressCity Province Postal CodeCountryHome TelephonePlease send all Crofton House School correspondence to this address.Household 2 - Parent/Guardian 1 (if applicable)Relationship to Applicant (eg. Mother, Father, Aunt, Guardian, etc.)First NameLast NameTitle (eg. Mr., Mrs.)Business Phone Cell EmailOccupationEmployerEmployer’s AddressParent Status Canadian Citizen and Resident of BC Landed Immigrant NOT residing in BCCanadian Citizen NOT residing in BC NOT Canadian Citizen and NOT Landed ImmigrantLanded Immigrant and Resident of BCHousehold 2 - Parent/Guardian 2 (if applicable)Relationship to Applicant (eg. Mother, Father, Aunt, Guardian, etc.)First NameLast NameTitle (eg. Mr., Mrs.)Business Phone Cell EmailOccupationEmployerEmployer’s AddressParent Status Canadian Citizen and Resident of BC Landed Immigrant NOT residing in BCCanadian Citizen NOT residing in BC NOT Canadian Citizen and NOT Landed ImmigrantLanded Immigrant and Resident of BC

SiblingsSiblings currently/formerly enrolled at Crofton House School:NameDate of Birth(mm/dd/yyyy)Current GradeYear(s) EnrolledSiblings applying/applied to Crofton House School:NameDate of Birth(mm/dd/yyyy)Current GradeCurrent SchoolOther siblings (please list all other siblings, both brothers and sisters):NameDate of Birth(mm/dd/yyyy)Current GradeCurrent SchoolLegacyPlease list any relatives who have attended Crofton House School:Name Relationship Year(s)AttendedGraduation Year Junior House Senior House

Student Questionnaire: Grades 4–12Please note: applicants for junior kindergarten to grade 3 do not need to fill out the followingquestionnaire.What are your reasons for wishing to attend Crofton House School?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What activities do you participate in at your current school ?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List any out of school lessons, programs, or activities in which you take part.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Parent QuestionnaireTo be completed by parent(s) or guardian of all applicants.In what ways do you expect that your daughter will contribute to the life of the school?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________In what way will you as a parent be involved in the life of the school?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please include any other information you think will be pertinent to your daughter’s application:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Academic and Character ReferencesPlease submit the names of two persons who have known your daughter in either an educational or personal setting as academicand character references. In addition to the information provided here, a letter of recommendation from each referencemust be forwarded to the school.Name Address Telephone Applicant RelationshipCrofton House Community ReferencesYou may also wish to supply references from individuals within the Crofton House community who support your daughter and/or your family’s application to the school. In addition to the information provided here, a letter of support from eachindividual listed must be forwarded to the school.Name Address Telephone Applicant RelationshipApplication ChecklistPlease be sure to complete all portions of this application form that are applicable to your daughter. In addition to submittingthis application form, we ask that you send the following supporting documents to the school:Copy of Applicant’s Birth Certificate, and, if not born in Canada, proof of Permanent Residency or Study/Work VisaParent’s Proof of Canadian Citizenship, Permanent Residency or Study/Work VisaA copy of most current report cardLetters from references listed (a maximum of four letters may be submitted)$350.00 application fee (please make cheque payable to Crofton House School)I UNDERSTAND THE FOLLOWING:(a) This application does not automatically admit thecandidate to Crofton House School. Admission is competitiveand depends upon the number of places available, testand interview results, academic transcripts and personalrecommendations.(b) It should be noted that full disclosure of all informationpertinent to your child’s application (academic, social, etc.)is expected. Failure to do so could result in withdrawal of anoffer of admission.(c) Should this applicant be accepted, the student and herparents or guardians agree to support the rules and valuesof the school and the Student Code of Conduct. Further,it is agreed that the student and/or a family be required toleave the school if, in the opinion of the Head of School, thepresence of such student and/or family is not in the bestinterest of Crofton House School.(d) Enrolment is for the full academic year, if a parentwithdraws a student in mid year they are responsible for thefull year’s tuition.(e) All fees are payable in advance (includes registration feeand tuition deposit) ALL FEES ARE NON-REFUNDABLE.(f) Fees not paid on time are subject to a $100 penalty perterm, plus monthly interest.SIGNATURE: FATHER / GUARDIANSIGNATURE: MOTHER / GUARDIAN

3200 West 41st Avenue, Vancouver, BC, V6N 3E1Tel: 604 263 3255 Email: admissions@croftonhouse.cawww.croftonhouse.ca