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<title>Application Form - KIS International School Thailand</title>
<script language="javascript">
function validate(form1)
{	 
	if((document.form1.cpi_name.value) == "")
	{
		alert("Please specify your name");
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		alert("Please specify reason");
		document.form1.si_question2.focus();
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	if((document.form1.si_question3.value) == "")
	{
		alert("Please specify child feelings");
		document.form1.si_question3.focus();
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	if((document.form1.si_question5.value) == "")
	{
		alert("Please specify year");
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<div class="header">
<img src="img/head.jpg" usemap="#head" border="0" title="Welcome to the KIS International School, Thailand" />
<map name="head">
<area shape="rect" coords="550,9,607,18" title="About KIS" href="about.html">
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<area shape="rect" coords="789,4,813,21" title="KIS International School - Japanese"href="img/KIS_International_School-jp.pdf">
<area shape="rect" coords="819,4,843,21" title="KIS International School - Chinese"href="img/KIS_International_School-ch.pdf">
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                        <table class="underline_content">
                        <tr>
                        <td><a href="index.php">Home</a> | <a href="application_form.php">Application Form</a></td>
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                            <ul>
                              <li><a href="index.php" title="Home">HOME</a></li>
                              <li><a href="about.html" title="About KIS">ABOUT KIS</a></li>
                              <li><a href="curriculum.html" title="Curriculum">THE KIS CURRICULUM</a></li>
                              <li><a href="learnerprofile.html" title="IB Learner Profile">IB LEARNER PROFILE (video)</a></li>
                              <li><a href="activities.html" title="Activities">ACTIVITIES</a></li>
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                              <li><a href="location.html" title="Our Location">LOCATION & TRANSPORTATION</a></li>
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                              <li><a href="employment/index.php" title="Employment">EMPLOYMENT</a></li>
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                              <li><a href="resources.html" title="Resources">RESOURCES</a></li>
                              <li><a href="bangkok.html" title="Moving to Bangkok">MOVING TO BANGKOK</a></li>
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<td align="center" valign="top">

	  <div align="left">
	  <div align="center" style="color:#FF0000"> <?=$_GET['msg']?></div>
	  <form id="form1" name="form1" onsubmit="return validate();" method="post" action="application_form3.php" >
	    <table width="100%" border="0" cellspacing="0" cellpadding="5">
          <tr>
            <td align="center"><span class="style3">Family Inquiry Form</span></td>
          </tr>
          <tr>
            <td align="center" ><span class="style4">Thank you for your interest in KIS. The following information will help us in the inquiry process.</span></td>
          </tr>
          <tr>
            <td bgcolor="#9ACCFF" class="style11"  style="border:1px solid  #666666"><table width="100%" border="0" cellspacing="0" cellpadding="0">
                <tr>
                  <td width="56%" bgcolor="#9accff"><span class="style15">Contact Person Information :</span></td>
                  <td width="44%" bgcolor="#9accff"><span class="style15">Top Three (3) Factors in Your Decision :</span></td>
                </tr>
            </table></td>
          </tr>
          <tr>
            <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td width="56%"><table width="100%" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
                      <tr>
                        <td>                          <input name="cpi_button_relation" type="radio" value="parent" />
                          Parent</td>
                        <td>                          <input name="cpi_button_relation" type="radio" value="guardian" />
                          Guardian</td>
                        <td><input name="cpi_button_relation" type="radio" value="others" />
                          Others
                          <input type="text" name="cpi_others" id="cpi_others" class="TextBoxStyle" style="width:118px" /></td>
                      </tr>
                    </table></td>
                  </tr>
                  <tr>
                    <td><table width="100%" border="0" cellspacing="0" cellpadding="5">
                      <tr>
                        <td width="25%" height="25">First Name                          </td>
                        <td width="75%"><input type="text" name="FName" id="FName" class="TextBoxStyle" style="width:80%" /></td>
                      </tr>
                      <tr>
                        <td>Last Name </td>
                        <td><input type="text" name="LName" id="LName" class="TextBoxStyle" style="width:80%" /></td>
                      </tr>
                      <tr>
                        <td colspan="2">Address </td>
                        </tr>
						<tr>
                        <td colspan="2"><textarea name="Address" class="TextBoxStyle" id="Address" style="width:295px" rows="4" ></textarea></td>
                        </tr>
                    </table></td>
                  </tr>
                  <tr>
                    <td height="25">Email &nbsp; <input type="text" name="Email" id="Email" class="TextBoxStyle" style="width:250px" /></td>
                  </tr>
                  <tr>
                    <td height="30">Level of English: 
                      
                      <input name="cpi_button_english" type="radio" value="excellent" />
                      Excellent 
                      
                      <input name="cpi_button_english" type="radio" value="good" />
                      Good 
                      
                      <input name="cpi_button_english" type="radio" value="fair" />
                      Fair 
                      
                      <input name="cpi_button_english" type="radio" value="none" />
                      None</td>
                  </tr>
                  <tr>
                    <td>&nbsp;</td>
                  </tr>
                </table></td>
                <td width="44%" valign="top"><table width="100%" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td><table width="103%" border="0" cellspacing="0" cellpadding="0">
                      <tr>
                        <td width="46%"><input name="top3_box[0]" type="checkbox" id="top3_box[0]" value="accessibility" />
                          Accessibility</td>
                        <td width="54%"><input name="top3_box[1]" type="checkbox" id="top3_box[1]" value="fee" />
                          Fee</td>
                      </tr>
                      <tr>
                        <td><input name="top3_box[2]" type="checkbox" id="top3_box[2]" value="classS" />
                          Class Size</td>
                        <td><input name="top3_box[3]" type="checkbox" id="top3_box[3]" value="studentT" />
                          Student: Teacher ratio</td>
                      </tr>
                      <tr>
                        <td><input name="top3_box[4]" type="checkbox" id="top3_box[4]" value="curriculum" />
                          Curriculum</td>
                        <td><input name="top3_box[5]" type="checkbox" id="top3_box[5]" value="schoolA" />
                          School Atmosphere</td>
                      </tr>
                      <tr>
                        <td><input name="top3_box[6]" type="checkbox" id="top3_box[6]" value="facilities" />
                          Facilities</td>
                        <td><input name="top3_box[7]" type="checkbox" id="top3_box[7]" value="reputation" />
                          Reputation</td>
                      </tr>
                      <tr>
                        <td><input name="top3_box[8]" type="checkbox" id="top3_box[8]" value="studentD" />
                          Student Diversity</td>
                        <td><input name="top3_box[9]" type="checkbox" id="top3_box[9]" value="other" />
                          Other
                          <input type="text" name="text_other" id="text_other" class="TextBoxStyle" style="width:100px" /></td>
                      </tr>
                      <tr>
                        <td colspan="2"><input name="top3_box[10]" type="checkbox" id="top3_box[10]" value="foreign" />
                          Foreign language acquisition</td>
                      </tr>
                    </table></td>
                  </tr>
                  <tr>
                    <td><table width="100%" border="0" cellspacing="0" cellpadding="5">
                      <tr>
                        <td>Home Phone
                          <input type="text" name="cpi_details[]" id="cpi_details[]" class="TextBoxStyle" /></td>
                        <td>Work Phone
                          <input type="text" name="cpi_details[]" id="cpi_details[]" class="TextBoxStyle" /></td>
                      </tr>
                      <tr>
                        <td>Mobile
                          <input type="text" name="cpi_details[]" id="cpi_details[]" class="TextBoxStyle" style="width:115px" /></td>
                        <td>Fax
                          <input type="text" name="cpi_details[]" id="cpi_details[]" class="TextBoxStyle" style="width:132px" /></td>
                      </tr>
                      <tr>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                      </tr>
                    </table></td>
                  </tr>
                </table></td>
              </tr>
            </table></td>
          </tr>
          <tr>
            <td bgcolor="#9ACCFF" style="border:1px solid #666666"><table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td bgcolor="#9ACCFF"><span class="style17">Student Information : </span></td>
                </tr>
            </table></td>
          </tr>
          <tr>
            <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td><table width="100%" border="0" cellspacing="0" cellpadding="2">
                    <tr>
                      <td colspan="2"><table width="100%" cellpadding="0" cellspacing="0" border="0">
                          <tr>
                            <td width="25%" align="center" >Child's Name (Nickname) </td>
                            <td width="12%" align="center" >Date of Birth </td>
                            <td width="14%" align="center" >Nationality</td>
                            <td width="23%" align="center" >Current School &amp; Country </td>
                            <td width="12%" align="center" >Grade Level </td>
                            <td width="14%" align="center" >Level of English </td>
                          </tr>
                          <tr>
                            <td colspan="6" align="center" ><table width="100%" border="0" cellspacing="0" cellpadding="2">
                              <tr>
                                <td width="25%" align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:130px" /></td>
                                <td width="12%" align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:70px" /></td>
                                <td width="14%" align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:80px" /></td>
                                <td width="23%" align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:130px" /></td>
                                <td width="12%" align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:65px" /></td>
                                <td width="14%" align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:65px" /></td>
                              </tr>
                              <tr>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:130px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:70px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:80px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:130px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:65px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:65px" /></td>
                              </tr>
                              <tr>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:130px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:70px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:80px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:130px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:65px" /></td>
                                <td align="center" ><input type="text" name="si_name[]" id="si_name[]" class="TextBoxStyle" style="width:65px" /></td>
                              </tr>
                            </table></td>
                            </tr>
                      </table></td>
                    </tr>
                    <tr>
                      <td colspan="2">&nbsp;</td>
                    </tr>

                    <tr>
                      <td colspan="2">&nbsp;</td>
                    </tr>
                    <tr>
                      <td width="52%">1. What other languages does your child (ren) currently speak?                        </td>
                      <td width="48%"><input type="text" name="si_question1" id="si_question1" class="TextBoxStyle" style="width:300px"/></td>
                    </tr>
                    <tr>
                      <td>2. Are you changing schools and if yes, what is the reason?                        </td>
                      <td><input type="text" name="si_question2" id="si_question2" class="TextBoxStyle" style="width:300px"/></td>
                    </tr>
                    <tr>
                      <td>3. How does your child (ren) feel about changing the school?                        </td>
                      <td><input type="text" name="si_question3" id="si_question3" class="TextBoxStyle" style="width:300px"/></td>
                    </tr>
                    <tr>
                      <td colspan="2">4. Who is responsible for making the decision? &nbsp; &nbsp;</td>
                    </tr>
					<tr>
						<td colspan="2">&nbsp;&nbsp;&nbsp;&nbsp;Parents 
                        <input type="text" name="si_question4a" id="si_question4a" class="TextBoxStyle" style="width:40px" />
                        % &nbsp;&nbsp;Child 
                        <input type="text" name="si_question4b" id="si_question4b" class="TextBoxStyle" style="width:40px" />
                        % &nbsp;&nbsp;Others 
                        <input type="text" name="si_question4c" id="si_question4c" class="TextBoxStyle" style="width:40px" />
                        %</td>
					</tr>
                    <tr>
                      <td>5. How long will your child attend KIS?</td>
                      <td><input type="text" name="si_question5" id="si_question5" class="TextBoxStyle" style="width:300px"/></td>
                    </tr>
                    <tr>
                      <td colspan="2">6. Where will your child go after secondary school? &nbsp;
                        <input name="si_button_willgo" type="radio" value="local" />
                        Local University &nbsp; <input name="si_button_willgo" type="radio" value="abroad" />
                        Abroad (country) 
                        <input type="text" name="si_question6" id="si_question6" class="TextBoxStyle" style="width:110px" /></td>
                    </tr>
                </table></td>
                </tr>
            </table></td>
          </tr>
          <tr>
            <td bgcolor="#9ACCFF" style="border:1px solid #666666"><table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td ><table width="100%" border="0" cellspacing="0" cellpadding="0">
                    <tr>
                      <td bgcolor="#9BCCFF"><span class="style17">Interested in School Bus Service?</span></td>
                      <td bgcolor="#9BCCFF"><span class="style17">When are you looking to enroll?</span></td>
                      <td bgcolor="#9BCCFF"><span class="style17">How much do you know about IB?</span></td>
                    </tr>
                </table></td>
              </tr></table>			  </td></tr>
			  <tr><td><table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
                    <tr>
                      <td><input name="school_bus" type="radio" value="yes" />                        
                        Yes</td>
                      <td><input name="enroll_button" type="radio" value="current" />
                        Current Term </td>
                      <td>                        <input name="how_much" type="radio" value="nothing" />
                        Nothing</td>
                    </tr>
                    <tr>
                      <td>                        <input name="school_bus" type="radio" value="no" />
                        No</td>
                      <td>                        <input name="enroll_button" type="radio" value="next" />
                        Next Term </td>
                      <td>                        <input name="how_much" type="radio" value="familiar" />
                        Familiar</td>
                    </tr>
                    <tr>
                      <td>If yes, please list location </td>
                      <td>                        <input name="enroll_button" type="radio" value="nextyear" />
                        Next Academic Year </td>
                      <td><input name="how_much" type="radio" value="alot" />                        
                        A lot, it is the reason </td>
                    </tr>
                    <tr>
                      <td><input type="text" name="bus_root" id="bus_root" class="TextBoxStyle" style="width:125px" /></td>
                      <td>                        <input name="enroll_button" type="radio" value="undecided" />
                        Undecided</td>
                      <td>we are interested in KIS </td>
                    </tr>
                </table></td>
              </tr>
              <tr>
                <td>&nbsp;</td>
              </tr>

            </table></td>
          </tr>
          <tr>
            <td><table width="100%" border="0" cellspacing="0" cellpadding="2">
              <tr>
                <td bgcolor="#9BCCFF" style="border:1px solid #666666" ><table width="100%" border="0" cellspacing="0" cellpadding="2">
				<tr>
				<td><table width="100%">
                    <tr>
                      <td width="65%" bgcolor="#9BCCFF"><span class="style10">How did you hear about KIS?</span></td>
                      <td width="35%" bgcolor="#9BCCFF"><span class="style10">Other schools you will visit / have visited</span></td>
                    </tr></table></td>
                    </tr>
                </table></td>
              </tr>
              <tr>
                <td><table width="100%" border="0" cellspacing="0" cellpadding="2">
                    <tr>
                      <td width="65%"><table width="100%" cellspacing="0" cellpadding="0">
                        <tr>
                          <td width="34%"><input type="checkbox" name="how_hear[0]" id="how_hear[0]" />
                            Embassy</td>
                          <td width="32%"><input type="checkbox" name="how_hear[1]" id="how_hear[1]" />
                            Word of Mouth</td>
                          <td width="34%"><input type="checkbox" name="how_hear[2]" id="how_hear[2]" />
                            Advertisement</td>
                        </tr>
                        <tr>
                          <td><input type="checkbox" name="how_hear[3]" id="how_hear[3]" />
                            Location</td>
                          <td><input type="checkbox" name="how_hear[4]" id="how_hear[4]" />
                            KIS Sibling</td>
                          <td><input type="checkbox" name="how_hear[5]" id="how_hear[5]" />
                            Exhibition</td>
                        </tr>
                        <tr>
                          <td><input type="checkbox" name="how_hear[6]" id="how_hear[6]" />
                            ISAT</td>
                          <td><input type="checkbox" name="how_hear[7]" id="how_hear[7]" />
                            Relocation Agent</td>
                          <td><input type="checkbox" name="how_hear[8]" id="how_hear[8]" />
                            Others</td>
                        </tr>
                        <tr>
                          <td><input type="checkbox" name="how_hear[9]" id="how_hear[9]" />
                            Internet / KIS Website</td>
                          <td>&nbsp;</td>
                          <td>&nbsp;</td>
                        </tr>
                      </table></td>
                      <td width="35%"><table width="100%" cellspacing="0" cellpadding="2">
                        <tr>
                          <td>1. 
                            <input type="text" name="visited_1" id="visited_1" class="TextBoxStyle" style="width:200px" /></td>
                        </tr>
                        <tr>
                          <td>2. 
                            <input type="text" name="visited_2" id="visited_2" class="TextBoxStyle" style="width:200px" /></td>
                        </tr>
                        <tr>
                          <td>3. 
                            <input type="text" name="visited_3" id="visited_3" class="TextBoxStyle" style="width:200px" /></td>
                        </tr>
                        <tr>
                          <td>&nbsp;</td>
                        </tr>
                      </table></td>
                    </tr>
                    
                </table></td>
              </tr>
              <tr>
                <td>&nbsp;</td>
              </tr>
              <tr>
                <td align="right"><table width="30%" border="0" align="center" cellpadding="0" cellspacing="0">
                  <tr>
                    <td align="right"><input type="reset" name="Reset" id="button" value="Reset" /></td>
                    <td align="left"><input type="submit" name="Submit" value="Send" /></td>
                  </tr>
                </table></td>
              </tr>
            </table></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
        </table>
        </form>
	  </td>
</tr></table>
	
<div class="footer" align="center">
							KIS International School,
							999/124 Kesinee Ville,
							Pracha-Utit Road,
							Huay-Kwang,
							Bangkok 10320,
							Thailand<br />
							T: +66 (0) 2274-3444 F: +66 (0) 2274-3452
                 </div>

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