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Medical Alerts:              Dili International School  Enrolment Form  Secondary   Years 7­10  2010 

Student Details: Family name:

Given names:

Name used: Gender:

DOB:

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: For students whose first language is not English, do you believe your child is capable of studying in the English language? YES/ NO It may be necessary for your child to undertake extra English language are you willing to pay this cost? YES/ NO Anticipated length of enrolment at DIS: Namesand agesof siblings: Family Details: Father’s name: Nationality: Phone:

Email:

Place of Employment:

Mother’s name:

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Phone:

Email:

Nationality: Place of Employment: Person to contact other than parent: 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

Pleaseprovide details: Schooling History: What grade has your child recently completed or currently studying How old was your child when he/she started formal schooling, and what was the grade called ie. Preschool, Kindergarten, Grade 1: School most recently attended and curriculum studied Pleaselist the subjects studied in previous academic year and provide academic transcripts supporting this information: 1 2. 3. 4. 5. 6. 7. 8.

Please list any other areas of particular interest your child has previously pursued and may like to continue at DISie instruments, sports, languages Health: Doesyour child have any cultural dietary restrictions? YES/NO Does your child have any medical conditions, disabilities or special requirements we should know about? YES/NO Pleaseexplain: Is your child allergic to any food, medicine, flora, fauna, sun protection cream? what?

YES/ NO

If so,

Is your child currently taking any medicine which you would like to be administered or monitored by school staff YES/ NO

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Is your child currently or has your child previously been under the care of a specialist health professional such as pediatrician, speech pathologist, physiotherapist, psychiatrist, psychologist etc (Pleaseexplain) YES/ NO Are there any further comments you wish to make about your child’s health:

Photography Teachers 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 etc. •

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.

Internet I agree to support DISStaff in implementing the Student Technology Policy

YES/ NO

Transport At times throughout the year your child may need to be transferred to and from school using school transport, private vehicle and /or by taxi. (1)

I give / do not give permission for my child to be transported by the school car to and

from local venues. (2)

I give / do not give permission for my child to be transported by private

vehicle (teacher/parent car) to and from local venues.

(3)

I give / do not give permission for my child to be transported by taxi to and

from local venues. General via email 

How do you wish to receive the weekly school Newsletter email

paper copy 

both  Do you have any special skills you would like to share with the school: YES/ NO Would you like to help out in the classroom on a regular basis:

YES/ NO

Our Secondary students undertake a careers information program. Are you interested in participating as a guest speaker: YE S/ NO Our Secondary students undertake work place experience. Are you interested to provide placement for a student at your work place: YES/ NO Fee Payment Doesyour employer pay for your school fees:

YES/ NO

Billing information: Enrolment Contract

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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 and I agree to cooperate with the FeePayment 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 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 as they see necessary.

I understand that in the event of injury and if staff see it as necessary my child will be immediately transported to the Australian Embassy Medical Clinic or the Dili District Hospital.

I understand that if my child becomes unwell while at school and we are unable to make contact with you and medical attention is deemed necessary, DIS staff will take your child to either the Australian Embassy Medical Clinic or the Dili District Hospital and I will be advised 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 would like to enroll my child into the Dili International School and will furnish all requested documentation to the administration office prior to my child commencing:

Parent Name:

Signature:

DISRepresentative:

Signature:

School Use:

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Discussion/Interview with management

Placement interview/discussion with Area teacher or Coordinator

Inspection of campus  FeesInformation Given  Completed enrolment form received and checked Enrolment approved by Principal/management

Copy of front page of child’s and parent’s passport or other photo identification received Authority for person other than parents to collect child completed Copy of Security Policy given

 Not necessary 

Copy of Student Technology Agreement Given  Copy of Transport Information Given  Relevant class information, term overview, newsletters given, extra curricular Copy of enrolment form given to Principal/Class teacher Student details Entered into:

Enrolment Register

 Admin Phone: 

Email List: 

Date Commenced: Name:

Signed:

Date:

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http://www.distimor.com/enrolment/Enrolment-Form-Secondary-2010  

http://www.distimor.com/enrolment/Enrolment-Form-Secondary-2010.doc

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