ss A. Student Details Family name First Given name First Given name Prefered First name GenderMenWomen DOB In which Year Student enrolled in their day school(mark only one box)k123456789101112 Is the student Overseas full fee paying student?YesNo Name of The community Language School IBIN ID Date of Enrollment in this school Day School Attended please provide detail of the day school where the student is currently enrolled Name of the School Attended Location of the school (suburb/tawn) B. Parent/Carer 1 with whom this Student normally lives Title(eg.Mr/Mrs/Dr) GenderMenWomen Relationship to student (eg mother/father/carer) Family name Given name Country of birth B.Parent/Carer 2 with whom this student normally lives Title(eg.Mr/Mrs/Dr) GenderMenWomen Relationship to student (eg mother/father/carer) Family name Given name Country of birth C.Parents/carers with whom this students normally lives Name 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 enrolledNoYes if you have a correspondence address that is different to your residential address please write it below Correspendence address if the school needs to contact a parent/carer , please specify in order o preferenece,who to contact B. Family Details Name of Prent/Carer to contact first Phone Number(mobile) Phone Number(home) Phone Number(work) Contact email address Name of Parent/carer to contact second Phone Number(mobile) Phone Number(home) Phone Number(work) Contact email address D.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 student Title(eg.Mr/Mrs/Dr) GenderMenWomen Relationship to student (eg mother/father/carer) Family name Given name Contact 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 Details Preferd email adress for corespondence Residential Address(eg 1 high street,sydney) does the student sometimes reside at this addressYesNo Correspendence address Additional 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 name Given name Relationship to student (eg neighbour/uncle) if there are any special conditions or times relevant to any contact number ,please include thes in the comment box next to the number Phone Number(mobile) Comment Box Phone Number(home) Comment Box Phone Number(work) Comment Box Contact Details(Second preference) Family name Given name Relationship to student (eg neighbour/uncle) if there are any special conditions or times relevant to any contact number ,please include thes in the comment box next to the number Phone Number(mobile) Comment Box Phone Number(home) Comment Box Phone Number(work) Comment Box The 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 Declaration I 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 name DOB Signature of Second parent/Carer Print name DOB