NEW ENROLLMENTS FOR 2023 ARE CURRENTLY CLOSED. THE FORM BELOW CAN BE USED TO REGISTER AN EXPRESSION OF INTEREST FOR 2024 INTAKE. THANK YOU. Your Digital Identity (IP Address): Please review the form carefully before submission. Student Information All fields marked with * are required / mandatory. Admission Number* Application Date* First Name* Middle Name Last Name* Date of birth* Gender* Male Female Place of Birth* Home Address* State* Suburb* Post Code* Email Mobile Number Is your child able to read, speak, write, listen to and comprehend instruction/lessons in English Language?* Yes No What measures have you taken for your child to fulfil the English language requirement?* Have you attended any Madrassa in Australia before?* Yes No Previous Madrassa Languages spoken at home* English Urdu Hindi Farsi Arabic Dari Other Mainstream School Details Mainstream school is the school attended on weekdays. School Name* School Suburb* School Address Student’s Year level* Is this student an overseas full-fee paying student?* Yes No Family Information Parental Status Single Parent/Guardian Partnered Relationship FatherMotherGrand FatherGrand MotherUncleAunt Salutation MrMrsDrMs First Name* Middle Name Last Name* Gender* Male Female Address Same address as above Home Address* State* Suburb* Post Code* Email* Mobile No* Occupation Relationship FatherMotherGrand FatherGrand MotherUncleAunt Salutation MrMrsDrMs First Name* Middle Name Last Name* Gender* Male Female Address Same address as above Home Address* State* Suburb* Post Code* Email* Mobile No * Occupation Siblings Information In case of no sibling click here Brother Sister Select Standardfiveseven Emergency Contacts This information is extremely vital in the event of an accident or medical emergency. If the Guardian(s) are not reachable then the contacts provided below will be approached.Emergency Contact Person 1 details: Contact Name* Home Phone Mobile Phone* Work Phone Relationship with child* Emergency Contact Person 2 details: Contact Name* Home Phone Mobile Phone* Work Phone Relationship with child* Medical and Behavioural Information Does your child have a diagnosed medical condition which might need first aid? Please choose yes or no and provide details if required. Severe allergies* Yes No Anaphylaxis* Yes No Food Intolerance* Yes No Asthma* Yes No Joint Condition* Yes No Heart Condition* Yes No Seizures/Epilepsy* Yes No Diabetes* Yes No Visual Impairment* Yes No Hearing Impairment* Yes No Other information For any other condition a separate Medical Management Form is required. Does your child need extra routine health support? (e.g. support with medication management, continence care, psychiatric issues)* Yes No Does your child need extra care/attention due to any of the following?* Autism Spectrum Disorder (ASD) Attention Deficit Hyperactivity Disorder (ADHD) Other issues None Family Court Orders Are there any current Court orders relating to this student?* Yes No Court Order Details* Please attach a copy of the order for the LOG’s records.* If circumstances change, please inform the LOG immediately. Declaration and Consent I/we agree to delegate my/our authority to supervising Light of Guidance (LOG) staff. Such supervising staff may take whatever disciplinary action they deem necessary to ensure the safety, well-being and successful conduct of the students as a group and individually.* Yes No Reason:* In the event of an accident or illness and contact with me/us being impracticable or impossible, I/we authorise LOG staff to arrange whatever medical or surgical treatment a registered medical or dental practitioner, hospital or ambulance service (including transport to a hospital) considers necessary. I/we will pay all ambulance, medical and dental expenses incurred on behalf of my/our child.* Yes No Reason:* I/we consent to the staff administering medication if so requested by me/we in writing using the appropriate medication authority form. I/we recognise all medication administered at the LOG will only be given if the medication has been prescribed by a registered medical practitioner; from its original container; bearing the original label with the name of the child to whom the medication is to be administered; and before its expiry or use by date. I/we understand that such medication should be administered in accordance with any instructions attached to the medication or written instructions provided by a registered medical practitioner using a medical management form.* Yes No Reason:* I/we agree to notify the LOG as soon as possible if my child will be absent.* Yes No Reason:* I/we agree to give two weeks written notice to withdraw my child from the LOG.* Yes No Reason:* There are times when children may be photographed or filmed: e.g. special events, newspaper articles, television news items. I/we give permission for my/our child to be filmed or photographed and for photos to be used for non-profit promotional purposes.* Yes No Reason:* I/we consent to my child’s name in the LOG newsletter/website for an undefined period of time.* Yes No Reason:* From time to time teachers will take classes on short local walks as part of the LOG’s educational program. These walks will take place at any time during the year. It is understood that in extreme heat or inclement weather conditions, such walks would not take place. I/we give consent for my/our child to go on short local walks. Note - excursions involving the use of transport or whole day activities are not included in this consent. For each excursion involving transport and/or a financial cost, a separate notice will be provided and separate consent forms collected.* Yes No Reason:* I/we give consent for my/our child to participate in any incursions the school may organise, where people share their skills, knowledge, experiences etc. with my/our child.* Yes No Reason:* I certify that LOG is the only Ethnic School my child attends.* Yes No My child is also enrolled at:* I declare that to the best of my knowledge the information contained in this form as stated above is correct. By submitting below, you declare that you have been made aware of and will abide by the policies of the LOG. You also declare that the information provided by you in this enrolment form is true and correct and that you will inform the LOG of any changes to this information as it occurs. Ethenic school policies are available for viewing or download at: https://www.esasa.asn.au/school-information/policies-for-ethnic-schools/ Privacy Disclaimer: The school acknowledges and respects the privacy of its community. The information that is being collect by the school is to process your enrolment. By completing this form, you have consented to this information being collected. The intended recipients of this information are the school, The Ethnic Schools Association of South Australia Inc. and for interaction with the Government of South Australia who provide funding to ethnic schools. The information collected will not be released for any form of commercial gain and will be maintained in a secure location as per the requirements of the Privacy Act. You have the right to access and alter personal information concerning yourself or your child in accordance with the Privacy Act 1988 and the school’s record management policy. The contact information of students will be shared publicly only when the express permission is given to the Ethnic Schools Association of South Australia to do so or under mandatory reporting requirements. Submitting form...
