Greek Orthodox Community of Melbourne and Victoria

ELA - For Toddlers

1. Student Details

Select Campus:*

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First Name:*

Please enter your first name.

Last Name:*

Please enter your last name.

Sex:*

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Date of Birth:*

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2. Health Details

Allergies:*

YesNoInvalid Input

Allergies Details:

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Anaphylaxis:*

YesNoInvalid Input

Does the student have Anaphylaxis requiring an Auto-Injector?
If yes you need to provide us with THREE COLOURED copies of the Action Plan For Anaphylaxis.

Asthma:*

YesNoInvalid Input

Does the student have Asthma?
If yes you need to provide us with a copy of the Asthma Action Plan.

Special Requirements / Needs / Illness / Disability:*

YesNoInvalid Input

Does the student have any needs that require special attention from the staff / teachers?

Special Requirements / Needs / Illness / Disability Details:

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(please provide details)

Immunisation Status Certificate/Statement:*

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If your child is not immunised you may put people’s health at risk, especially those too young, too old or unable to be immunised for medical reasons. Therefore for the safety of the other students attending, we will not be accepting children without a current Immunisation History Statement.

3. Home/Family Details

Street Address:*

Please enter your address.

Home Suburb:*

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Home PostCode:*

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Home Phone:*

Please enter your phone number.

4. Parent / Guardian 1

Name:*

Please enter the name of your emergency contact.

Parent/Guardian Relationship:*

Please provide the nature of the relationship.

Mobile Phone:*

Please enter the Parent/Guardian's personal telephone number.

Email:

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5. Parent / Guardian 2

Name:

Please enter the name of your emergency contact.

Parent/Guardian Relationship:

Please provide your contact number.

Mobile Phone:

Please enter the contact number of your emergency contact.

Email:

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Work Phone:

Please enter the contact number of your emergency contact.

6. Emergency Contact (in case guardians are not available)

Name:*

Please enter the name of your emergency contact.

Phone Number:*

Please enter the contact number of your emergency contact.

Relationship:*

Please enter the relationship you have with your emergency contact.

7. Legal Restrictions

Legal Restrictions:*

YesNoInvalid Input

Are there any legal restrictions such as court orders in relation to the student or parents?
If yes you need to provide us with a copy of the Court's Orders.

Legal Restrictions Details:

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8. Photo Permission

Photo Permission:*

YesNoInvalid Input

I consent to and provide permission for the photographic, video or audio recording of my child / student, to be used by authorized personnel in various communications and media (e.g. School Newsletter, Website, Displays and Folders of the Greek Afternoon Schools, etc).
I understand that my child / student will not be personally identified in any use of the material.
I authorize the use or reproduction of any recording referred to above without acknowledgment and without being entitled to remuneration or compensation.

9. Privacy Policy Details (accepted by submitting this form)

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, 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: http://www.education.vic.gov.au/Pages/privacy.aspx

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.

10. Payment Details

Total Amount $*

Please enter a number.

$200 per quarter.

Name on Card:*