Home/Student Enrolment Form Student Enrolment Form Melbourne Bangla School ABN: 66 311 201 176, REG: A0099196N Fawkner Primary School, 40, Lorne Street, Fawkner, VIC 3060 Email: melbournebanglaschool@gmail.com, Phone: 0433752970 First name: Family name: Middle name(s): Date of birth: Email Address Phone Number Gender Male Female Others Home Address : Postcode Student’s Mainstream School Name: Student’s Mainstream Year Level: Student's Residency Status Australian citizen/Permanent resident Fee paying international student Other If Other, please specify: Parent/Guardian Details Name of Parent/Guardian: Relationship to student: Work phone: Mobile phone: Email: Emergency Contact Details (only complete if different from parent/guardian details) Emergency contact name: Emergency contact phone: Relation to student: Medical Information Does your child suffer from any medical condition? (e.g. asthma, epilepsy, allergies etc.)? Yes No If Yes, please specify and provide a medical plan (e.g. asthma, anaphylaxis etc.) Is your child currently on any medication? Yes No If Yes, please specify: 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 fulfill legal obligations including duty of care, anti-discrimination 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: 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 being reasonably necessary including disclosing personal and health information to professional third parties in the event of a medical emergency Name of Parent/Guardian: Date of Submission Submit Share Facebook
