Private School in San Diego, International Application

APPLICATION FOR INTERNATIONAL ADMISSION

All sections must be filled out completely (write N/A if the information is not applicable).

STUDENT INFORMATION

School year applying for:

Student’s Family Name (surname):

First Name (given):

Middle Name:

Suffix (First, Second, Third):

American Name:

Date Of Birth (month/date/year):

Gender: FM

Country of Birth:

Country of Citizenship:

Country of Permanent Residence:

Current Grade Level:

Grade Level when attending Balboa School:

How many years would you like to study at Balboa School?

Date you would like to begin your studies:

How did you learn about Balboa School?:

FAMILY INFORMATION

Father's Name:

Email address:

Mothers's Name:

Email address:

Permanent address in home country:

City:

Province/Territory:

Country:

Zip:

Telephone Number:

Do both parents understand and speak English? Yes / No If no, which is the best way to communicate with parents?

Who will be your legal guardian while studying at Balboa School (name & phone number)?

AGENCY INFORMATION

Placement agency or name of person who is assisting with application:

Telephone Number:

Email address:

Homestay agency:

Telephone Number:

Email address:

SCHOOL INFORMATION

Previous School & year(s) attended:

School:

Grade & Year attended:

School:

Grade & Year attended:

I-20 INFORMATION

If you are currently in the US now, please complete below before going on to the next section. If not, please skip to the next section.

What is your immigration status?

If you currently have an F-1 Visa, what is your SEVIS ID #?

Purpose of requesting a form I-20 from BCS is to:

transfer in:

region F-1 status:

I am currently attending school in the US?

Yes/No: YesNo

If yes, name of school:

Dates of attendance:

Do you want your form I-20 mailed to your foreign address? If not, where would you like it mailed?

Name & Telephone Number:

I do not want my form I-20 to be mailed. I would like it picked up by:

FINANCIAL INFORMATION

You may refer to Balboa School’s estimated annual cost to calculate total expenses.

Sponser #1

Name of person financially responsible:

Total amount this person is giving me each year for tuition:

Total amount this person is giving me each year for living expenses:

Sponser #2

Name of person financially responsible:

Total amount this person is giving me each year for tuition:

Total amount this person is giving me each year for living expenses:

Sponser #3 - Free Room and Board

Name of person I will be living with for free:

Consequent to any payment made to Balboa School, I understand and agree I will not receive a refund.

Sponsor/Parent Name (please print):

Sponsor/Parent Signature:

Date:

MEDICAL INFORMATIONN

My child is currently being treated for the following medical conditions:

My child has allergies?

Please list:

Please select if your family has a history of:

Other conditions:

My child takes medications:

Name of medication:

Dosage and frequency:

All medications must be turned into the office along with a prescription medication form (available in the office).

In case of an emergency, I give permission for Balboa School to seek, authorize, and consent to any medical treatment or care necessary
for my child. This authorization, hereby granted to Balboa School, shall continue in effect until such time as I make direct contact with
the treating doctor. This authorization in no way obliges Balboa School or its authorized representatives, to pay or be liable for any costs
or expenses incurred in the care of or treatment of my child; and I agree to pay all costs and expenses incurred for the treatment and case
of my child.

Parent/Guardian Name (please print):

Parent/Guardian Signature:

Date:

PROGRAM PARTICIPATION

I understand:

Throughout the course of the year, students at Balboa School take a variety of field trips. These trips range from visiting museums to
touring college campuses. We consider it an integral part of our program that students become exposed and interact within the
community around them. Students will either walk, take a taxi, or ride with parent volunteers. I understand my child will go on off
campus field trips with Balboa School. I understand that the staff of Balboa School will take reasonable care of my child, but I also
recognize that they will be off campus and may occasionally encounter hazards beyond the staff’s control. I agree to be fully responsible
and hold harmless Balboa School, and any of its employees and parents, from any and all liability for any and all harm arising to my child
as a result of participating. This will hold true while my child attends Balboa School.

Balboa School maintains the right to all student-generated work produced, created, or developed at Balboa School by my child. It also
maintains the right to use my child’s image in stills, video tape recordings or other media, such as the internet and/or yearbook, in such a
way as it deems fit for now or in the future for publicity or other purposes. My child’s name may be used in conjunction with Balboa
School events, publicity and other ways as it deems fit now or in the future for publicity or other purposes. Balboa School has my
permission to use photos and student-generated work.

Parent/Guardian Name (please print):

Parent/Guardian Signature:

Date:

HOMESTAY RELEASE

I agree to be fully responsible and hold harmless Balboa School, and its representatives from any and all claims, demands, costs or
damages incurred by my child or out of the actions of the Homestay family. I also agree that at my own expense to defend any suit or
action brought against Balboa School instituted upon the claim of such damage to persons or property. This will hold true while my child
attends Balboa School.

Parent/Guardian Name (please print):

Parent/Guardian Signature:

Date:

International Application

APPLICATION FOR INTERNATIONAL ADMISSION

STUDENT INFORMATION

FAMILY INFORMATION

AGENCY INFORMATION

SCHOOL INFORMATION

I-20 INFORMATION

FINANCIAL INFORMATION

MEDICAL INFORMATIONN

All medications must be turned into the office along with a prescription medication form (available in the office).

PROGRAM PARTICIPATION

HOMESTAY RELEASE

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