* Required

It is the intention of the school to ensure that all students achieve success in their pursuit of the school mission. Should a student be significantly unsuccessful (academically, socially or behaviorally), interventions will be implemented with the intention of supporting that student’s success. The outcome of this may be that continued enrollment is only possible with additional learning or behavioral support (for which additional costs may be payable) and parent consent to this recommendation may be a requirement for continued enrollment at NIS. While NIS is an inclusive school that seeks to meet the needs of a range of learners, should it become clear that the success of a student is not feasible at NIS, or that the cost to other learners is unacceptable (due to, for example, poor behavior), NIS has the right to ask a student to withdraw.

We confirm that all information submitted is accurate and that all pertinent information needed to assess our child’s suitability to enroll and participate in all NIS program activities (except as noted on this form) has been presented in a truthful manner. 

We confirm that we have read the “Implications and Responsibilities” above, and that if this application results in admission to NIS, we agree to accept and abide in full by all of the responsibilities listed above. 

We give permission for NIS staff and administration to provide necessary medical care and support for our child’s needs, and agree to abide by the rules and procedures for health care as outlined in the “Medical Information & Permission Form”. 

We understand that this form may be photocopied and information may be shared with members of the NIS staff. 

We understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document. 私達は、上記の記載事項は事実と相違ないことを認め、本欄へのチェックが法的に有効な署名に代わるものであることを了承します。 

Parent 1 (or Legal Gardian) Signature*required

Date*required (mm/dd/yyyy)

Parent 2 (or Legal Guardian ) Signature

Date (mm/dd/yyyy)

Student Name *required

(Last, First)​

Add Student?

Yes 

Student Name 2*required

Add Student?

Yes 

Student Name 3*required

Add Student?

Yes 

Student Name 4*required