Medical Alerts: Dili International School Enrolment Form Primary 2010 Transition to Year 6 Please complete this form and forward it to email@example.com or the administration office Student Details Family name: Given names: Name used: Gender: Date of birth: Country of Birth: Nationality: Country living in prior to coming to Timor Leste: In order of proficiency what language/s does your child speak and what language/s is mostly spoken at home: Anticipated length of enrolment at DIS: Names and ages of siblings: Family Details Fatherâ€™s name: Nationality: Phone: Place of Employment: Motherâ€™s name: Nationality: Phone: Place of Employment:
Person to contact in emergency other than parents: Name: Relationship to child: Phone: Email: Are there any custody issues DIS should know about to best protect the interests of your child? YES/NO
Please provide details:
Who other than parents will drop off and collect your child? Name: Contact details: If this person is unknown to DIS staff (not another parent) it is necessary to complete the form Child Collection Authorization available from the office and provide 3 passport photos. This relates to children in grade 2 and below. Education History How old was your child when he/she started formal schooling, and what was the grade called ie. Preschool, Kindergarten, Grade 1? What grade has your child recently completed or was recently studying? What school has the student most recently attended and which curriculum was studied? Please provide a copy of previous years report. Health Does your child have any medical conditions, disabilities or special requirements we should know about? YES / NO Please explain: Does your child require routine/or occasional administration of any medication to be given by classroom staff? YES / NO If yes please explain and provide a written request to your class teacher listing â€“ medication, dosage, administration times. Do you consent to staff giving Panadol to your child to reduce high fever if we are unable to make contact with you. YES / NO Is your child allergic to any food, medicine, flora, fauna, sun protection cream? and what is the reaction?
YES / NO
If so, what
Has your child previously been under the ongoing care of a health professional? paediatrician, psychiatrist etc. YES / NO Please explain: Social Information Does your child have any cultural dietary restrictions: YES/NO Does your child have any cultural practices it is useful for us to know about: YES/ NO Does he/she have any particular behaviors you feel it would be useful for us to know about: YES / NO General
Staff regularly take photographs of students for use in weekly newsletters, for assessment purposes, to illustrate performance in class based activities, as a record on excursions and camps, and for displays I give / do not give permission for photographs of my child to be taken for any of the above stated purposes. I give / do not give permission for photographs of my child to appear on the Dili International School website. How do you wish to receive the weekly school Newsletter? No q via email q paper copy q Both q Would you like to help out in the classroom on a regular basis, or do you have any skills you wish to share with the students? YES / NO If yes, what and when are you available: Does your family have any need for an Afternoon Care facility? YES / NO Please Explain: Does your family have any need for a School Holiday Program? If affordable school transport was made available would your family use this service?
YES / NO
Fees Does your employer pay your school fees? Please explain and/or provide billing information:
Enrolment Contract •
I have read the Dili International School Information Booklet and I agree to cooperate with established policy, protocol and procedure.
I have read the document pertaining to fee payments, I am aware that upon receipt of this application form DIS management will issue an invoice for fees and I agree to cooperate with the Fee Payment conditions.
I understand that Dili International School cannot secure insurance in Timor Leste and agree that the school, staff, volunteer staff or associated agencies will not be held responsible or financially liable in the event of an accident or injury to my child.
To comply with DIS Security Policy I will submit to the office copies of the front page of the Passport for both parents/guardians as well as my child.
I understand that in the event of emergency DIS staff will administer First Aid treatment as staff see necessary.
I understand that in the event of an emergency my child will be immediately transported to the Australian Embassy Medical Clinic or the Dili District Hospital and staff will make contact with me as soon as possible.
I have read the DIS Security Policy and am aware of action to be taken in the event of a Security problem.
I wish to enroll my child into Dili International School and will ensure all requested documentation is given to the administration office prior to my child commencing:
School Use: Discussion/Interview with management q Placement interview/discussion with Principal /area teacher or Coordinator q Inspection of campus q Family Information Booklet Given q Fees Information given q Completed enrolment form received and checked q Enrolment approved by Principal/management q Copy of front page of childâ€™s and parentâ€™s passport or other photo identification received q Authority for person other than parents to collect child completed q Not necessary q Copy of Security Policy given q Relevant class information, term overview, canteen menu, newsletters given q Completed enrolment form given to Principal/Class teacher q Student details entered into: Enrolment Register q Admin Phone: q Email List: q Class enrolled into: Name:
Date Commenced: Signed: