Tulip School Registration form 2022-2023

Registration form 2022-2023
Have you previously registered?*
If you are new to our school and you want to enroll your child, please contact Karen Kong Kon Fook first at tulipschool@tulipschool.org or phone 773-575-3677.
Student details

If you wish to register more than one child you can easily do this by indicating the number of children you wish to register in the dropdown list directly below. The correct number of registration forms will then appear.
How many children do you wish to register?*
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Registration form for first pupil
Name of first student*

SurnameFirst name
Male/Female
Date of birth*

MonthDayYear
Place of birth*
Country of birth*
Nationality/nationalities*
Allergies*
If yes, which?*
Medications*
If yes, which?*
Other considerations*
Vaccinations received?*
If no, which ones?*
Education
Last Dutch education:
Last level of Dutch education
Name of School
Country of School
School year
Upload report from last school

Upload a File

Cancelof
Current education:
Name of School
State
Grade
Choose the school of your choice
Chicago
VO (Highschool)
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Registration form for second pupil
Name of second student*

SurnameFirst name
Male/Female*
Date of birth*

MonthDayYear
Place of birth*
Country of birth*
Nationality/nationalities*
Allergies*
If yes, which*
Medications*
If yes, which*
Other considerations*
Vaccinations received?*
If no, which ones?*
Education
Last Dutch education:
Last level of Dutch education
Name of School
Country of School
School year
Upload report from last school

Upload a File

Cancelof
Current education:
Name of School
State
Grade
Choose the school of your choice
Chicago
VO (Highschool)
------------------

Registration form for third pupil
Name of third student

SurnameFirst name
Male/Female*
Date of birth*

MonthDayYear
Place of birth*
Country of birth*
Nationality/nationalities*
Allergies*
If yes, which?*
Medicines*
If yes, which?*
Other considerations*
Vaccinations received?*
If no, which ones?*
Education
Last Dutch education:
Last level of Dutch education
Name of School
Country of School
School year
Upload report from last school

Upload a File

Cancelof
Current education:
Name of School
State
Grade
Choose the school of your choice
Chicago
VO (Highschool)
------------------

Registration form for fourth pupil
Name of fourth student*

SurnameFirst name
Male/Female*
Date of birth*

MonthDayYear
Place of birth*
Country of birth*
Nationality/nationalities*
Allergies*
If yes, which?*
Medications *
If yes, which?*
Other considerations*
Vaccinations received?*
If no, which ones?*
Education
Last Dutch education:
Last level of Dutch education
Name of School
Country of School
School year
Upload report from last school

Upload a File

Cancelof
Current education:
Name of School
State
Grade
Choose the school of your choice
Chicago
VO (Highschool)

Extra Information
If this is not your first registration, you only have to complete the required fields along with any changes you wish to notify us of.
Family details
Family name*
Address*

Town/CityState

ZIP
Home telephone
Parents
Name of first parent*

SurnameFirst name
Mobile*
E-mail *
Nationality
Profession
Name of employer*
Work phone
- - - - - - - - - - - - - -
Name of second parent*

SurnameFirst name
Mobile*
E-mail *
Nationality
Profession
Name of employer*
Work phone
Other contacts in case of an emergency
If you are new to the area, tick this box for now. On sending this form you will receive a link, so you can always return to it later and add an emergency contact.

Fill in later
Extra Contactperson*

SurnameFirst name
Relation
Home phone
Mobile
2nd person?
Extra Contactpersoon

SurnameOfficial name
Relation
Home phone
Mobile
Doctor
Name of Doctor
Address

CityState

ZIP
Phone number
Dutch Language
Since which date have you resided in the US?*
Is Dutch spoken at home?*
By who?*
Which language is the most dominant?*
Does your child speak or understand Dutch?*
What do you do at home regards learning Dutch?*
Children in the family
Number of Children
Name
Date of birth

MonthDayYear
Name
Date of birth

MonthDayYear
Name
Date of birth

MonthDayYear
Name
Date of birth

MonthDayYear

Payment details
The tuition can be paid yearly or in four installments (only if enrolled prior to September 1st). Payments can be made by check (payable to Tulip School) or by Zelle (tulipschool@tulipschool.org).
Payments

You are legiable for reduced tuition fees if your employer does not contribute. (if your employer will only partially reimburse tuition fees, Tulip School will expect you to pay the balance).
Will your employer reimburse tuition fees?*
How much does your employer pay or reimburse?
Choose how you wish to pay, yearly or quarterly*
Installment payments only possible if student has enrolled prior to Sept 1st, 5% discount only for yearly payments.
Preferred payment method
Would you like to receive a printed invoice?

YesNo
Voluntary Contribution to the school
Make cheques payable to 'Tulip School'
Please choose the amount times you can volunteer for the school *
Please state your area of interest? i.e. Board/cultural activities/expertise?*
Payment by check or by Zelle should be made on receipt of the invoice.
Checks must be made payable to Tulip School and sent to:

Tulip School
26419 Silverleaf Dr
Plainfield IL 60585
Liability clause

The Tulip School is not liable for damages of any kind or extent whatsoever, by students and/or their parents that may be suffered as a result of actions and events which may occur in school. Tick the box if you consent to The Tulip School that, for the above child(ren), in the case of an emergency and 9-1-1 is dialled and the required (medical) support is enabled, hereby you will be liable for all expenses that the afformentioned support may bring.
Liability*

Please cross box to show accordance
Please state below if you grant permission to the Tul(i)p, first Dutch language school in Chicagoland representatives, to take and use: photographs and/or digital images of your child(ren) for use in news releases and/or educational materials as follows: printed publications or materials, electronic publications, or websites. You authorize the use of these images without compensation. Names and identities will not be revialed. All negatives, prints, digital reproductions shall be the property of the Tul(i)p, first Dutch language school in Chicagoland.
Photographic consent*
Sender
Name*

SurnameFirst name
E-mail address*
Town/City*
Date*

MonthDayYear
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Registration form 2022-2023

Extra Information

Payment details