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Ancient Greek For Secondary-School Students
 
1. Student Details
First Name:*
Please enter your first name.

Last Name:*
Please enter your last name.

Gender*
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Date of Birth:*
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2. Details Required by the Department of Education
Mainstream School Name for 2018:*
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Mainstream School Campus for 2018:*
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Mainstream School Year Level for 2018:*
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This Student's residence status is:*

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Other, please specify:
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Other After-Hour Greek Language School:*

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Other Greek Language School Details:
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Dep. Ed. Privacy Collection Notice*
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

Dep. Ed. Privacy Consent (you agree to this when you submit the form)*
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.

3. Student Medical Details
Allergies:*
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Allergies Details:
Invalid Input

Anaphylaxis:*
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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:*
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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:*
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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)

Doctor's Name:
Please enter the name of your emergency contact.

Doctor's Address:
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Doctor's Phone:
Please enter the contact number of your emergency contact.

4. 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.

6. Parent / Guardian #1
Name:*
Please enter the name of your emergency contact.

Mobile Phone:*
Please enter the Parent/Guardian's personal telephone number.

Email: *
Invalid Input

Parent/Guardian Relationship:*
Please provide the nature of the relationship.

Work Phone:
Please enter the contact number of your emergency contact.

7. Parent / Guardian #2
Name:
Please enter the name of your emergency contact.

Mobile Phone:
Please enter the contact number of your emergency contact.

Email:
Invalid Input

Parent/Guardian Relationship:
Please provide your contact number.

Work Phone:
Please enter the contact number of your emergency contact.

7. 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.

8. Legal Restrictions
Legal Restrictions:*
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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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9. Photo Permission
Photo Permission:*
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  1. 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).
  2. I understand that my child / student will not be personally identified in any use of the material.
  3. I authorize the use or reproduction of any recording referred to above without acknowledgment and without being entitled to remuneration or compensation.
10. Select a course
Select Course:*
Please select a course

Tuition Amount:
Please select a course

Course Book Amount:
Please select a course

Course Book Details:
Please select a course

Book Option:
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Total Amount $*
Please enter a number.

11. Payment Details
Name on Card:*
Please confirm your Credit Card Details.

Cardholder Address:*
Please confirm your Credit Card Details.

Card Number:*
Please confirm your Credit Card Details.

Visa or MasterCard

Card Expiry (mm/yy):*
Please confirm your Credit Card Details.

Card CVC:*
Please confirm your Credit Card Details.

Human Verificiation:
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Alphington Grammar Koinotika Nea - the Greek Community newsletter Requirements for Greek Citizenship

 

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