Registration Form for 2021-2022 School Year:

Student Information

Family Information


Consent to Treatment

We, the undersigned parents or guardians of the afore-listed student, a minor, do hereby consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital service that may be rendered to said minor under the general of speical instruction of any physician Kosrae Seventh-day Adventist may call, whether such diagnosis or treatment is rendered at the office of said physician or at a licensed hospital. It is understood that reasonable effort will be made to contact the parents and emergency contact listed above before treatment is begun. It is further understood that this consent is given in advance of any specific diagnosis or treatment which might be required and is given to authorize KSDAS or the physician to exercise their best judgment as to the requirement of such diagnosis or treatment. A photocopy of this authorization shall be considered as effective and valid as the original.


Your signature below indicates that the information you have provided is accurate to the best of your knowledge. Also, together (parents and student) you have read and understood the Kosrae Seventh-day Adventist School Handbook, recognizing that the regulations adopted by the school administration and publicly announced (verbally and/or in writing) will be as binding as those printed in the handbook. By signing below you imply a willingness to cooperate with policies and regulations in the handbook and/or stated throughout the school year. You also demonstrate your desire to work with the school as we provide a quality Christian education for all of our students.