Greek Orthodox Community of Melbourne and Victoria

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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:*

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Mainstream School Campus:*

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Mainstream School Year Level:*

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This Student's residence status is:*

An Australian Citizen / Permanent Resident

A full-fee paying international student

Other (please specify below)

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Other, please specify:

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Other After-Hour Greek Language School:*

This is the ONLY/FIRST Greek Language School this Student has ever attended and will not be attending a different one at the same time.

This Student has PREVIOUSLY attended a different Greek Language School but is no longer enroled there (specify previous other school below).

This Student is/will be attending OTHER/MULTIPLE Greek Language Schools at the SAME TIME as this one (specify current other Greek School name below).

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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:*

YesNoInvalid Input

Allergies Details:

Invalid Input

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:

Invalid Input

(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:*

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:

Invalid Input

9. 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.

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:

I already own the coursework.Invalid Input

Total Amount $*

Please enter a number.

Instalments Option

If you would like to pay in instalments instead please send an email to courses@greekcommunity.com.au with your details

11. Payment Details

Name on Card:*