BRUNSWICK SINHALA LANGUAGE SCHOOL (BSLS) Established in 1992 ABN 48510159629 STUDENT RE / ENROLMENT FORM

BRUNSWICK SINHALA LANGUAGE SCHOOL (BSLS) Established in 1992 / ABN 48510159629 STUDENT RE / ENROLMENT FORM
STUDENT PERSONAL DETAILS:

Important: Names on this form must be the same as the names known by or used at the main stream school.
Student Name*

First NameMiddle NameLast Name
Birth Date*

DayMonthYear
Gender:*

FemaleMale
STUDENT RESIDENTIAL DETAILS
Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Australian Residency status*

Australian CitizenPermanent ResidentOther
STUDENT SCHOOL DETAILS
Mainstream School Name*
Suburb/Post code*

Street Address

Street Address Line 2

CitySuburb

Post code
Mainstream school class level*
BSLS Class Level 2024*
Student currently attending any other language school*

YesNo
If yes please provide the name of the language school
Student previously attended any other language school*

YesNo
If yes please provide the name of the language school
STUDENT MEDICAL DETAILS & CONSENT
Medicare /Health Insurance Number*
Current Ambulance Subscription or Heath care card*

YesNo
Family Doctors Details. (address & contact details)*
Does the student have any severe medical condition or allergy reaction? (if yes, please request and fill out the Allergy form )*

YesNo
Medical Declaration.(In the event that the parents are unable to be contacted.) In the event of illness, injury to my child while at school, an excursion or travelling to or from school during the excursion, I authorize principle/president or a senior staff member to, attend to emergency medical treatment as this necessary by the medical practitioner.*

YesNo
Does the student up to date with immunisation*

YesNo
NAME & GRADE OF SIBLING(S) ATTENDING THE SCHOOL

	Name	Year Level 2024
Sibling 1
Sibling 2
Sibling 3

PARENT/GUARDIAN INFORMATION & MEMBERSHIP DETAILS FOR BRUNSWICK SRI LANKAN COMMUNITY GROUP INC.
Parent/Guardian Name Father/ Male Guardian*

First NameLast Name
Relationship to Student*
Contact Number *
Please enter a valid phone number.
Email*
example@example.com
Resident Status*

Australian CitizenPermanent ResidentOther
Skills that can be offered*
Other
Do you have "WORKING WITH CHILDREN" Certificate?*

YesNo
If “yes” CARD NO
Expires on

MonthDayYear
Parent/Guardian Name Mother/ Female Guardian*

First NameLast Name
Relationship to Student*
Contact Number *
Please enter a valid phone number.
Email*
example@example.com
Resident Status*

Australian CitizenPermanent ResidentOther
Skills that can be offered*
Other
Do you have "WORKING WITH CHILDREN" Certificate?*

YesNo
If “yes” CARD NO
Expires on

DayMonthYear
EMERGENCY CONTACT DETAILS
Emergency contact 1*

First NameLast Name
Relationship to Student
Phone Number*
Emergency contact 2*

First NameLast Name
Relationship to Student
Phone Number*
PRIVACYCOLLECTION 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 educator 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*

YesNo (Please contact school principle)
PARENT/GUARDIAN PRIVACY CONSENT AND DECLARATION
I consent to: -
1. The collection of my child’s health and personal information by the community language school.
2. 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.
3. 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.
4. Provide consent to receive E-mails, share information with Department of Education and other promotional materials and event
details of the BSLS via website, e-mail, SMS and other electronic and non - electronic media.
5. I agree publishing my child’s photographs /work as outlined above and will notify BSLS, if I decide to withdraw this consent
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 agree to use my printed name as legal representation of my signature for this application just
the same as a pen-and-paper signature.
Name of Parent /Guardian*
Date*

DayMonthYear
Date
Should be Empty:

BRUNSWICK SINHALA LANGUAGE SCHOOL (BSLS) Established in 1992 / ABN 48510159629 STUDENT RE / ENROLMENT FORM

STUDENT PERSONAL DETAILS:

STUDENT RESIDENTIAL DETAILS

STUDENT SCHOOL DETAILS

STUDENT MEDICAL DETAILS & CONSENT

NAME & GRADE OF SIBLING(S) ATTENDING THE SCHOOL

PARENT/GUARDIAN INFORMATION & MEMBERSHIP DETAILS FOR BRUNSWICK SRI LANKAN COMMUNITY GROUP INC.

EMERGENCY CONTACT DETAILS

PRIVACYCOLLECTION NOTICE-PROTECTING YOUR PRIVACY AND SHARING INFORMATION

PARENT/GUARDIAN PRIVACY CONSENT AND DECLARATION