KPS Enrolment Form

STUDENT’S PERSONAL DETAILS

Family Name

Given Name:

Date of Birth:

Sex:(Male/Female)

Address:

Postcode:

Telephone:

Email:

Name of Mainstream School:

Suburb:

Year Level in day School:

Year Level in Ethnic School:

FATHER’S/MALE GUARDIAN’S DETAILS

Family Name:

Given Name:

Relationship with Student:

Country of Birth:

Emergency Contact Number:

Vaccination confirmation – Full / Partial:

MOTHER’S/FEMALE GUARDIAN’S DETAILS

Family Name:

Given Name:

Relationship with Student:

Country of Birth:

Emergency Contact Number:

Vaccination confirmation – Full / Partial:

If other, please specify:

Is your child currently enrolled at another community language school to learn the same language?: YesNo

If Yes, which school?:

Privacy Collection Notice - Protecting your privacy and sharing information

The information about your child and family collected through this enrolment form will only be shared with school staff who need to know to enable the community language school and Department of Education and Training (Department) to educate or support your child, or to fulfil legal obligations including duty of care, antidiscrimination law and occupational health and safety law. The information collected will not be disclosed beyond the Department without your consent, unless such disclosure is lawful. For more about information-sharing and privacy, see the Department’s privacy policy at: https://www.education.vic.gov.au/Pages/privacy.aspx

List any allergies or medical condition(s) the student is suffering:

Signature of Parent/Guardian:

(Father/Mother/Guardian)

Accident Declaration

In the event of illness or injury to my child whilst at the school, or an excursion, or travelling to or from the school, authorise the Principal or senior staff member in-charge of my child, where it is impractical to communicate with me, to consent to emergency medical arrangements on my behalf as are deemed necessary by a qualified medical practitioner, such consent includes anaesthesia or blood transfusion and operations.

Signature of Parent/Guardian:

Parent/Guardian Privacy Consent and Declaration

I confirm that the information provided on this enrolment form is true and correct and I acknowledge and agree to the terms and conditions of enrolment accompanying this enrolment form. I consent to:

the collection of my child’s health and personal information by the community language school.
the community language school disclosing my child’s personal information contained in this enrolment form to the Department of Education and Training for data verification and funding purposes.
the Principal or teacher (where the Principal or teacher in charge is unable to contact me) to administer such first
aid to my child as the Principal or staff member may consider to be reasonably necessary including disclosing personal and health information to professional third parties in the event of a medical emergency.

Name of Parent/Guardian:

Signature of Parent/Guardian:

Date: