Enrolment – Islamic School of Canberra

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Student Name *

Year/ Grade *

Student Passport Photo *

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Student Details

Family Name *

First Name *

Preferred Name *

Date Of Birth *

Documentary Evidence Required

Gender *

Male
Female

Do you identify as Aboriginal or Torres Strait Islander? *

Birth Country *

Country Of Citizenship *

Main Language *

Spoken At Home

Citizenship *

Australian Citizen
Permanent
Temporary

Birth Cirtificate *

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Parent Details

Title *

e.g. Mr. / Mrs. / Dr.

Family Name *

e.g. Mr. / Mrs. / Dr.

First Name *

Do you identify as Aboriginal or Torres Strait Islander? *

Religion *

Relationship To Child *

Home Address

Email Address *

Mobile Number *

Work Place *

Occupation/ Job Position *

Country Of Birth *

Country Of Citizenship *

Main Language *

Spoken At Home

English Speaking? *

Highest Level Of Education *

Grade pain ticked

Student Others Information

Please tick if your child suffers from any of the following: *

Anaphylaxis
Asthma *
Diabetes *
Fainting
Allergies
Blood Pressure
Eczema
Headaches/ Migraines
Fits or Blackouts
Hay Fever
Epilepsy *
Sight/ Hearing Problems
Nose Bleeds
Reaction To Drugs
Heart Condition
Sunscreen Sensitivity
Others

What are the other problems that your child is suffering? *

Describe the sign or symptoms if you ticked a box above *

If you have ticked any of the boxes above, does your child require specific first aid treatment (that is, specific instructions provided by your child's doctor) in addition to standard first aid treatment? *

If Yes, a General First Aid Plan is to be completed and provided to the school along with specific instructions provided by the doctor.

Note: For anaphylaxis*, asthma*, diabetes* or epilepsy* conditions, please ask the family doctor to provide a specific First Aid Plan.

Is the student presently taking any medication? *

If Yes, please state name of medication, dosage, etc.: *

Please inform the school of any changes to medication.

Parents must give written permission and directions for the administration of any medication.

In all cases, medication must be labelled with the student's name, dosage and frequency of administration.

I consent to my child receiving paracetamol for temporary pain relief. Also, I consent for my child to receive first aid treatment should there be a need. I authorize the school to call an ambulance if needed in case of emergency. *

Signature *

Clear Signature

Date *

Our students take part in activities both inside and outside the school where there is potential for them to be photographed.

The purpose of this note is to clarify the circumstances under which vou are happy far your chi1d or children to have their photographs taken

I consent to my child

being photographed under the following cicumstances.

Please tick which apply : *

I agree to my child's image appearing in the school newsletter.
I agree to my child's image appearing in the school website.
I agree to my child's image appearing in the school's annual yearbook.
I agree to my child's image appearing in the official school class photo.
I agree to my child's image appearing in external media (Example: newspapers magazines, television)

Name of Parent *

Date *

Signature *

Clear Signature

Islamic School of Canberra is bound by the Commonwealth Privacy Act 1988. The school is committed to upholding the principles in the Act and complying with the Privacy Act at all times. A full copy of the Islamic School of Canberra Privacy Policy is available on the Policies page on the school website and can be accessed by clicking here.

ISC is mandated (will only) to use personal information only for the purposes fo- which it was given to us or for purposes which are related (or directly related in the case of sensitive information) to one or more of our functions or activities.

ISC Will use the information provided onlv for enrolment and may share it with ACT State and Commonwealth Government agencies and other organisations authorised or required by law.

Information will be stored securely and confidentially. If you would like to access or correct any personal information, or, if you have any concerns about the collection use or disclosure of personal information, you should contact the school on (02 62887358)

I hereby consent to ISC to disclose my details and information which I have provided to any authorised government agencies or required by law.

Name of Parent *

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