Enrollment Form A. Student DetailsFamily NameFirst Given NameSecond Given NamePrefered First NameGenderMaleFemaleDateIn which Year Student enrolled in their day school(mark only one box)k123456789101112Is the student Overseas full fee paying student?YesNoName of The community Language SchoolIBIN IDDate of Enrollment in this schoolDay School Attended please provide detail of the day school where the student is currently enrolledName of the School AttendedLocation of the school (suburb/tawn)B. Parent/Carer 1 with whom this Student normally livesTitle(eg.Mr/Mrs/Dr)GenderMenWomenRelationship to student (eg mother/father/carer)Family nameGiven nameCountry of birthB.Parent/Carer 2 with whom this student normally livesTitle(eg.Mr/Mrs/Dr)GenderYesNoRelationship to student (eg mother/father/carer)Family nameGiven nameCountry of birthC.Parents/carers with whom this students normally livesName to be used for all correspondence(eg Mr and Mrs A black , Ms B Green)Residential Address(eg 1 high street,sydney)Is this the residential address of the student to enrolledYesNoif you have a correspondence address that is different to your residential address please write it belowCorrespendence addressIf the school needs to contact a parent/carer , please specify in order o preferenece,who to contactB. Family DetailsName of Prent/Carer to contact firstPhone Number(mobile)Email AddressName of Parent/carer to contact secondPhone Number(mobile)Email AddressD.Parents/Carer not living with this student Complete only if applicable. please print and attach additional pages if required for multiple parent/carer not living this studentTitle(eg.Mr/Mrs/Dr)GenderMaleFemaleRelationship to student (eg mother/father/carer)Family nameGiven nameContact Details If there is are any special condition or times relevant to any contact number, please include in the comment box nest to the number(eg. Mondays and Tuesday)Phone Number(mobile)Phone Number(home)Phone Number(work)Family DetailsPreferd email adress for corespondenceResidential Address(eg 1 high street,sydney)does the student sometimes reside at this addressYesNoCorrespendence addressAdditional Emergency Contacts Please nominate two people ovevr the age 18 years who may be contracted in the event of an emergency if the community language school is unable to contact the parents/carers listed in the section C. Please make sure that you have discussed with these people with their willingness to be emergency contacts Contact Details(first preference)Family nameGiven nameRelationship to studentIf there are any special conditions or times relevant to any contact number ,please include thes in the comment box next to the numberPhone Number(mobile)Comment BoxPhone Number(home)Comment BoxPhone Number(work)Comment BoxContact Details(Second preference)Family nameGiven nameRelationship to studentFf there are any special conditions or times relevant to any contact number ,please include thes in the comment box next to the numberPhone Number(mobile)Comment BoxPhone Number(home)Comment BoxPhone Number(work)Comment BoxThe personal information collected on this information form is for purposes directly related to your child’s attendance at a community languages school,including the processing of applications for grant funding from the NSW Community Languages Schools Program, administered by the NSW Department of Education. Any information provided to the Department of Education and will be used, disclosed and stored consistent with the NSW privacy laws. Certain information is required by the Department of Education to meet its obligations in relation to data collection, reporting and the payment of grants. Information may be disclosed to NSW State and Commonwealth government agencies and other organisations for the purposes of confirming the eligibility of students for grant funding and as authorised or required by law. Information will be stored on a secure electronic database. You may access or correct the information by contacting your child’s community language school. The community language school is responsible for advising the NSW Department of Education and of any corrections required to the electronic database. If you have a concern or complaint about the information collected or how it has been used or disclosed you should contact the community language school. Your consent and DeclarationI have provided information related to the student in this enrolment form.I consent to providing information contained on this enrolment form to the Department of Education and to confirm the accuracy of the information with other organisations that may also hold information related to the student named on page 1. I have read the information on this page concerning the collection ofpersonal information. I declare that the information provided in this enrolment form is, to the best of my knowledge and belief, accurate and complete. Where I have given personal information about other people I have done so with their authorisation.I am aware that if information I have given is false or misleading, any decisionmade as a result of this enrolment form may be changed.Signature of Parent/Carer(at least one of the student’s parents/carers must sign the enrolment form)Print nameDOBSignature of Second parent/CarerPrint nameDOBSubmit Form