2019 - 2020 DSSV registration form
Enrollment at the beginning of the school year or after the winter break

• Age: The school accepts children of age 5 till 18 and children of age 4 who will turn 5 before September 1st 2019. Parents of children who will turn 5 after September 1st 2019, please contact us at info@dutchschoolsiliconvalley.org

• Open house - there is an open house during the summer break and after the winter break, where children can experience a class and parents get information as well as a 10 minute personal intake. Enrollment is only possible after attending the open house. If you can not attent, please contact us at info@dutchschoolsiliconvalley.org

• Enrollment fee: There is a one-time only non-refundable enrollment fee of $100 (per new family). This fee is waived for returning families or expanding/changing family enrollment.

Email address *
Registration and emergency information
We'd hereby like to register our child (children) for the 2019 - 2020 schoolyear of the Dutch School Silicon Valley
Last name *
Your answer
Street address *
Your answer
City *
Your answer
Zipcode *
Your answer
First name child 1 *
Your answer
Date of birth child 1 *
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/
DD
/
YYYY
First name child 2
Your answer
Date of birth child 2
MM
/
DD
/
YYYY
First name child 3
Your answer
Date of birth child 3
MM
/
DD
/
YYYY
In case of a major emergency your child can only be released to:
First and last name of father/mother (or male/female guardian) *
Your answer
Cell phone number of father/mother (or male/female guardian) *
Your answer
Email address of father/mother (or male/female guardian) *
Your answer
First and last name of (other) father/mother (or male/female guardian) *
Your answer
Cell phone number of (other) father/mother (or male/female guardian) *
Your answer
Email address of (other) father/mother (or male/female guardian) *
Your answer
Any things we need to know (allergies, learning challenges etc)
Your answer
At all times the Dutch School Silicon Valley (the “School”), and its board members, directors, officers, administrators, staff (a.o. teachers and teaching assistants), employees, volunteers and agents, are authorized to take any measures necessary for the protection of my child(ren) during the hours of the 2019 - 2020 DSSV classes and events.
English speaking families
Dutch speaking families
Comments :
Your answer
We are attending the open house on *
Class schedule / time slots
We strive towards scheduling students with the same age (grade), language skills, and background in the same time slot. Making the best possible schedule is quite a challenge. Your co-operation/flexibility is appreciated.

To give an indication, please find below the timeslots of last schoolyear (2018-2019):

• Berkeley

Tuesday afternoon - 4 PM till 6.30 PM
Wednesday afternoon - 4 PM till 6.30 PM

• San Francisco

Thursday afternoon - 3.45 PM till 6.15 PM

• San Jose

Tuesday afternoon - 3.45 PM till 6.15 PM

• Palo Alto

Tuesday afternoon - 3.45 PM till 6.15 PM
Wednesday afternoon - 3.45 PM till 6.15 PM
Thursday afternoon - 3.45 PM till 6.15 PM
Saturday morning - 10 AM till 12.30 PM

The above schedule is subject to change from schoolyear to schoolyear.

Please tell us which location you would like to register your child for : *
Required
Which day of the week has your preference? *
Which other day(s) would work as well? * *
* We’ll use this information to explore possible day changes or to add a day/timeslot to our schedule.
Required
Which day does NOT work?
Payment
For new families, there is a one-time non-refundable enrollment fee of $ 100 (per family). This fee is waived for returning families or expanding/changing family enrollment.

The regular tuition for the 2019 - 2020 schoolyear will be $145 per month per child.

Discount policy
• For families with 3 children enrolled in our program, we offer a 50% discount on the tuition of the third child.

After your child(ren) is/are placed, you will receive an form to set up automatic payment via ACH or PayPal.

If you have any questions or special requirements please contact our treasurer at penningmeester@dutchschoolsiliconvalley.org

Cancellation
Enrollment for the school is for the duration of the entire school year. If you cancel before the end of the school year, a cancellation period of 30 days applies. School fees will be charged for these 30 days, even when students are no longer able to attend class. You can cancel by emailing the director and treasurer via wieneke@dutchschoolsiliconvalley.org and penningmeester@dutchschoolsiliconvalley.org
Waive and release
The undersigned (the “Signer”), being the parent(s) and/or legal guardian(s) of the minor child(ren) (the “Child”) named at the beginning of this form , for valuable and sufficient consideration, receipt of which is hereby acknowledged, on behalf of themselves and the Child do hereby knowingly and intentionally fully and irrevocably release, to the full extent permitted by California law, the Dutch School Silicon Valley (the “School”), and its board members, directors, officers, sponsors, administrators, staff (a.o. teachers and teaching assistants), employees, volunteers and agents, from any and all claims or liability, known or unknown, of any kind whatsoever, which may now exist, or at any time in the future arise, with regard to any matters relating, directly or indirectly, to the Child’s enrollment or attendance at the School, or to the Signer’s or the Child’s participation in any activities directly or indirectly related to, or sponsored or sanctioned by, the School, regardless of whether or not said activities occur on School premises or elsewhere. By our initials below and by our signatures at the end of this form, we knowingly waive and release any and all legal claims that we or the child(ren) may now or in the future have against the School, or anyone connected with it.
Initials *
Your answer
To the best of our knowledge, all the information filled in on this registration form is true and complete. We have read the requirements and are fully committed to complying with them. We understand that payment of the required fees must be made by the payment deadlines outlined. Our signatures below affirm all of the above.
Signature of father/mother (or male/female guardian) *
Your answer
Signature of (other) father/mother (or male/female guardian) *
Your answer
Filling in this form is done at your own risk.
A copy of your responses will be emailed to the address you provided.
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