Camp Form - Raffles American School

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Camp Form

First Name *

Middle Name

Family Name *

Western Name (if applicable)

Gender *

Female

Male

Date of Birth *

Age *

Nationality *

City of Residence *

Passport Number *

Country Issuing Passport *

Photocopy of Student's Passport *

Maximum file size: 134.22MB

Boarding or Non-Boarding?

Boarding

Non-Boarding

Which camp are you registering for? *

Camp 1 Date: 15th - 26 January 2024

Camp 2 Date: 29 January - 9 February 2024

Camp 3 Date: 12 February - 23 February 2024

School Representative or Agent (Answer 'No' if not applicable) *

Is the student vegetarian? *

Siblings

Does the applicant have siblings or family members attending the camp at RAS? (If yes, choose 'other' and state siblings name)

No

OtherOther

Family Information

Primary Local Address in Malaysia *

Mother's Name *

Chat App *

Mother's Chat App Number *

Mother's Email *

Father's Name *

Chat App *

Father's Chat App Number *

Father's Email *

Emergency Contact (Preferably Family Member or Friend in Malaysia)

Name *

In case parent/guardian cannot be reached, please provide a local contact (e.g. friend, colleague, relative), if you do not have any contact person in Malaysia, you may leave close contact in your country as well.

Emergency Contact's Phone Number

Relationship to Student *

Languages

Languages Spoken *

Primary language spoken at home *

Camp T-Shirt Size

Available Sizes

Kid - X-Small

Kid - Small

Kid - Medium

Kid - Large

Kid - X-Large

Kid - 2XL

Adult - Small

Adult - Medium

Adult - Large

Adult - X-Large

Adult - 2XL

Support Services

Are there any behavioral or learning support needs that we should be aware of? *

Student Health Record

Does your child have any present illness? *

No

OtherOther

If yes, please choose 'other' and provide details.

Does your child suffer from any allergies? *

No

OtherOther

If yes, please choose 'other' and provide details of cause, effect, and whether your child takes any medication for it.

Does your child experience any learning difficulties or mental impairments that we need to be aware of in order to cater for the needs of your child? *

No

OtherOther

If yes, please choose 'other' and specify.

Can your child swim? *

No

yes

Does your child have a history of asthma? *

No

yes

Does your child cary an asthma inhaler? *

No

yes

Does your child wear glasses or contact lenses? *

No

yes

Does your child have trouble hearing or use a hearing aid? *

No

yes

Is there any health condition or any limitations on your child's physical ability that the school should be aware of? *

No

OtherOther

If yes, please choose 'other' and specify.

Is your child on daily medication? *

No

yes

Do the camp staff need to administer the medicine to the child during the day? *

No

yes

Please state the time and frequency required to administer daily medicine.

Please choose the medication that NOT allowed to give to your child

None

Tylenol

Panadol

Ibuprofen

Aspirin

Antacid

Sudafed

Medical or Insurance Copies

Maximum file size: 134.22MB

Terms and Conditions *

Agree

I have read, understood and agreed to the Activity/Trip/Camp Consent Form as annexed together with this Application Form and the Brochure/Information of the Camp as annexed in Annexure A. This Application Form, the said Activity/Trip/Camp Consent Form and the said Brochure/Information of the Camp shall be taken together as constituting the entire contract between the parent(s) and the school. I undertake and agree to pay the fee (amount invoiced by the school) on or before the timelines provided by the school. I understand that all payments are non-refundable.

If you are human, leave this field blank.

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General Information

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About RAS

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Raffles American School

Jalan Raffles, 79050 Iskandar Puteri, Johor Darul Takzim, Malaysia

+60 (7) 213 2638

inquiry@raffles-american-school.edu.my

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