English WL Summer Camp Application Form 2012 by ipP7R82S


									C--Pii® Educattiionall Systtems & Schooll Managementt Serviices
C P ® Educa ona Sys ems & Schoo Managemen Serv ces
     Tel: + 9714 3625191/0 • Fax: + 9714 3664511• Efax: + 1419 8582933• 24 Hrs Hotline: + 97150 6884675
      Website: www.cpieducation.com •Email: register@cpieducation.com / contactus@cpieducation.com

 ِReg. No.                                Weight Loss Camp 2012
                                               Dubai -United Arab Emirates
                                                             Registration Form

 Please indicate below the type of application that you are making:

 A. Student Information
 First Name:          _______________________________                           Gender:                    Male         Female

 Middle Name:         _______________________________                           Nationality:              _______________________

 Surname:             _______________________________                           Country of Residence:     _______________________

 Date of Birth:       ___________/__________/_________                          Visa Status:              _______________________

 Native Language: _______________________________                               2nd Language:             _______________________

 Mailing Address: ________________________________________________________________________________

 B. Parents/Guardians Information

 Name:                _______________________________                           Occupation:               ______________________

 Telephone (Res.): _______________________________                              Telephone (Work):         ______________________

 Fax Number:          _______________________________                           Mobile Phone:             ______________________

 Nationality:         _______________________________                           Email Address:            ______________________

 Mailing Address: _______________________________________________________________________________


 Name:                _______________________________                           Occupation:               ______________________

 Telephone(Res.): _______________________________                               Telephone(Work):          ______________________

 Fax Number:          _______________________________                           Mobile Phone:             ______________________

 Nationality:         _______________________________                           Email Address:            ______________________

 Mailing Address: _______________________________________________________________________________

 C. Contact Information
 In case of emergency who should we contact?
 Name:                _______________________________                           Telephone:                ______________________
 Name:                _______________________________                           Telephone:                ______________________

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                             MEDICAL & OTHER REQUIREMENTS
D. Disclosure of Important Medical Information:
Please add below any additional information you may think is necessary as regards to your child’s education, health, and
well-being. Please include information about any medical condition that the student may be suffering from or has suffered
from in the past. This must include any and all allergies and all medication prescribed. Please also include all vaccinations
taken in the past. This information will remain confidential, and will be disclosed only in cases of medical or dental

E. Parental Authorization for Emergency Medical/Dental Treatment:
C-Pi® will make every effort to maintain a secure and healthy environment for the students in its care. Students will be
supervised and monitored around the clock, and a nurse will be present on the premises until 06.00pm on weekdays, with a
doctor on call 24 hours/day throughout the duration of the camp.
All possible preventative measures will be taken, but in the case of accidents, parents will be notified immediately; first
priority will be to provide students with necessary emergency medical/dental treatment. This requires parental authorization.
Please complete and sign the form below:
                           Authorization for Emergency Medical and/or Dental Treatment:

I ______________________________________________ parent/guardian of ___________________________________
give full and unrestricted authorization to C-Pi® Educational Systems & School Management Services, and any and all
authorized representatives of it to approve any and all emergency medical and/or dental treatment to my child named above
in urgent cases of accident. Please refer to Section E above.

Signature of Parent/Guardian: ____________________________________________                                Dated: ___/___/___

F. Visit Visa Request :
C-Pi® facilitates entry visas to Dubai for students residing outside the United Arab Emirates who wish to attend the camp.
The following nationalities will be granted a free visit visa upon arrival in Dubai WITHOUT APPLICATION: Citizens of
Andorra, Australia, Austria, Belgium, Brunei, Canada (no longer applicable as of January 1 st 2011), Cyprus, Denmark,
Finland, France, Germany, Greece, Holland, Hong Kong, Iceland, Ireland, Italy, Japan, Liechtenstein, Luxembourg,
Malaysia, Malta, Monaco, New Zealand, Norway, Portugal, San Marino, Singapore, South Korea, Spain, Sweden,
Switzerland, United Kingdom, United States of America, Bahrain, Kuwait, Qatar, Oman, Saudi Arabia, and Vatican City.
All other nationalities: C-Pi® will facilitate student applications for visit visas through its corporate headquarters with C-Pi®
as guarantor, as follows:
    a)   All students (and their parents) attending the camp should travel through Dubai International Airport. C-Pi® will
         arrange for all overseas participants to be picked up from the airport on their arrival, and dropped off upon their
    b)   Clear copies of the visitor's passport should be submitted with the completed Application Form.
    c)   Charges for visit visas will vary depending on nationality and may reach up to US$2000/-. These charges will still
         apply in instances of the visa not being used, or being rejected by the Immigration Authorities.
    d)   Please note: visit visas may take up to 10 days to issue, and residence permits may take up to 30 days.
• Yes, I wish to apply for a visit visa for my child. I have enclosed the necessary documentation.
• Yes, I wish to apply for a visit visa for myself/my family. I have enclosed the necessary documentation.

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                                        CURRICULUM/COURSE SELECTION
G. Academic History
Please indicate schools attended by applicant:

School:                     _______________________________             Attended from:        ___/___/___     to:      ___/___/___
School:                     _______________________________             Attended from:        ___/___/___     to:      ___/___/___
School:                     _______________________________             Attended from:        ___/___/___     to:      ___/___/___
School:                     _______________________________             Attended from:        ___/___/___     to:      ___/___/___

Grade completed during Academic Year 2011/12:                           _______________________________________________

H. Morning Classes:

    All students will be required to attend morning classes covering the obligatory Health Science course in addition to
    Morning classes will be held on weekdays (Sunday to Thursday). Two lessons (45 minutes each) per subject will be
     scheduled bringing total teaching time to four lessons per day. These are separated by a 30 minute snack break. Classes
     begin at 09.00am and end at 01.00pm.
    The camp offers a number of subjects taught at various levels to suit all standards of academic attainment. Students will
     be tested to evaluate their achievement level to date, and will be placed in classes accordingly.
    Parents/students may indicate their first, second, and third preferences of subject. Classes will be allocated according
     to availability and need.
    Parents/students must specify a preferred course aim ; either:
            i.          To solidify and strengthen students’ knowledge structure through a revision of material studied at school
                        during the past academic year.
            ii.         To provide students with a head-start on material that will be covered at school in the coming academic
            iii.        Extra-curricular courses that will enhance general knowledge and expand students’ interests.

    Course Aim
                                                                        World       Social                      Math        English
Select from i, ii, or iii     Subject      Math   Sciences   English                            Art   Music                             IT
                                                                       Languages   Sciences                   Foundation   Foundation
     from above
                              1st Choice
                              2nd Choice
                              3rd Choice

Note: Books for selected subjects will be provided by C-Pi®, and are included in the tuition package.

                                        EXTRA-CURRICULAR ACTIVITIES
I. General Activities:
i - Activities:
Included in the boarding package are participation costs for a wide variety of extra-curricular clubs and activities including:
theatre, storytelling, chess, technology etc. Enrolment in these clubs and activities will take place during the first week of the
If there are any specific extra-curricular activities in which you would not like your child to participate, please list them here:

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H. ii - Sports Leagues:
Included in the boarding package are participation costs for sports leagues that are internally organized and supervised by
qualified sports instructors. They include: soccer, softball, volleyball, basketball, tennis, swimming etc. Enrolment in these
leagues will take place during the first week of the camp.
If there are any specific sports or sport-related activities in which you would not like your child to participate, please list
them here:

I. Trips:
i - Weekday Evening Trips:
Evening outings are to local leisure activity centers, and include ice-skating, bowling, paint-balling, mini-golf and the
cinema. These run from 6.30-9.30pm twice a week, according to schedule. Transportation costs and entrance fees are
included in the fees.

ii -Weekend Trips:
Weekend trips are all-day excursions to local shopping complexes on Fridays, and to cultural and leisure locations both in
Dubai, and in other cities and regions of the United Arab Emirates including Sharjah, Al-Ain, Fujairah and Khor Fakkan on
Fridays. These trips are all undertaken under careful supervision to ensure the safety of our students. Transportation costs
and entrance fees where necessary are included in the tuition fees.

J. Additional Activities
Additional lessons are available at an extra fee as listed below. These are given by contracted independent instructors, take
place both off and on-site, and are available at beginner, intermediate, and advanced levels as required. Please note:
      Horseback riding available for ages 11-17 years only. Classes in horseback riding are ½ hour only.
      All other classes are 1 hour and open to students of all ages.

           Class                      Regular Program: 1 session/week               Intensive Program: 2 sessions/week
                              Cost for      Please      Cost for     Please    Cost for     Please     Cost for     Please
                              3 weeks       check       5 weeks      check     3 weeks      check      5 weeks      check
                               (US$)          as         (US$)         as       (US$)         as        (US$)         as
                                           required                 required               required                required
Horseback riding                350                       600                    700                    1,200
Tennis (individual lessons)     350                       600                    700                    1,200
Golf (group lessons)            350                       600                    700                    1,200
Piano/Keyboard                  250                       450                    500                     900
Violin/Qanun                    250                       450                    500                     900
Guitar/Oud                      250                       450                    500                     900
Flute/Nai                       250                       450                    500                     900
Saxophone/Trumpet               250                       450                    500                     900

K. Hot Meals:
          Students attending the camp will be served three meals daily.
          A set menu for each meal has been selected that takes into account the diverse and international nature of the
           camp’s student community.
          All menus will rotate on a ten-day basis.

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L. Boarding Facilities:
 Boarding facilities are available for students aged 11 years to 17 years old.
 Rooms are arranged in a centrally-supervised single-sex dormitory structure.
 Students are grouped in dorms/rooms first by age, then according to common classes/interests.
 Individual dorms are monitored around the clock by live-in Third Parents who are available to students 24 hours a
  day. Dorm regulations will apply.
 Laundry will be collected once a week for washing and ironing, and returned within 3 days of collection.
 Students will be required to mark their cloths with a unique student number that will be allocated upon registration.

Full boarding applicants that have friends or relatives in the UAE, and would like to spend the weekend with them may do so
subject to pre-approval by parents. A written request should be submitted by the hosts at least three days before the start of
the required weekend. All students should return by 06.00 pm on Saturday at the latest.

Please name authorized friends or family members with whom your child may stay while in the UAE:
Host 1: __________________________________________                  Tel: _________________________________________
Host 2: __________________________________________                  Tel: _________________________________________

M. Pocket Money Deposit:
Although boarding is all-inclusive in terms of meals, board and other related expenses, students will require pocket money
for snacks, shopping trips, personal needs and so forth. This is of course at the parents’ discretion, but C-Pi® sets and collects
an average of US$10 per day as a Pocket Money Deposit for each student. This is dispensed once a week, and parents are
requested to set the maximum weekly dispensable amount below:

Maximum amount dispensable per week (US$):                 _____________________________________________________

N. Telephone Calls Deposit
Students may make local and international calls from their rooms on a booking basis only. Such calls will be logged, and the
cost of such calls will be deducted from the Telephone deposit made by the parents. The size of this deposit is of course at
the parents’ discretion, but C-Pi® recommends an average of US$3 per day as a Telephone Calls Deposit for each student.
Please complete and sign the authorization form below.

• I authorize my child to make local and international calls according to the conditions listed below:

Authorized numbers                    Maximum weekly call limit (US$)              Maximum total call charges (US$)

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                                               FEES & PAYMENT

O. Weight Loss Camp-Summer 2012

     i – Selection of enrollment period:
          The Weight Loss Camp 2012 will run for the duration of summer. Parents may select one of the following options
          to enroll their boys or girls. Please check required sessions below:
          □         Option 1: Duration of 3 weeks-                From July 1st, 2012 to July 19th, 2012.
          □         Option 2: Duration of 5 weeks-                From July 1st, 2012 to August 2nd, 2012.
     ii – Fees & Payment:
          a)    The full fees for the Weight Loss Camp-Summer 2012 are payable at the time of registration. These include:

                        i.   Fees amounting to US$3,500/- for Option 1(3 weeks) or US$5,300/- for Option 2(5 weeks)
                       ii.   Pocket Money Deposit as decided by the parents as per Section M of this application form.
                      iii.   Telephone Deposit as decided by the parents as per Section N of this application form.
                      iv.    Additional charges for selections made by the parents/guardians as outlined in Sections J of this
                             form are payable at the time of registration.

          b)    All fees should be paid by telex transfer to C-Pi®’s account ONLY after the completion of the application
          c)    Fees once paid are non-refundable. No discounts will be applicable for early withdrawal.

I ___________________________________________________ parent/guardian of ________________________________
hereby declare that I have read, understood and accepted the terms and conditions of enrollment of my child as outlined in
all sections of this application form (6 pages), and guarantee that the information submitted in my application is valid and
true to date.

Signature of Parent/Guardian _________________________________________________                          Dated: ___/___/___

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