Medical Alerts: Dili International School Enrolment Form Playgroup /Junior Preschool 2010 Please complete this form and forward it to firstname.lastname@example.org 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: If verbal, 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 be accompanying your child to Playgroup of Junior Pre -school. Please ensure you introduce this person to staff. Name: Relationship to child: Phone:
Who other than parents and carer (as advised above) will drop off and collect your child? Name: Contact details: If this person is unknown to DIS staff (not another parent) it is necessary complete the form Child Collection Authorization available from the office and provide 4 passport photos. 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 for permission. Yes / No Is your child allergic to any food, medicine, flora, fauna, sun protection cream? what and what is the reaction?
YES / NO
Has your child previously been under the ongoing care of a health professional psychiatrist etc.? YES / N0 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 Has your child previously attended a group care situation: YES / NO Please describe his/her general personality e.g. outgoing, withdrawn, enjoys own company, enjoys music etc: Does he/she have any particular behaviors you feel it would be useful for us to know about: YES / NO
How much regular contact does she/he usually have with other children: Is your child independent with toileting: YES / NO Please describe your child’s eating habits: 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. I would like to receive the fortnightly newsletter No via email paper copy Both 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: If it was possible to stay on a DIS for a full day with afternoon care after the morning session, may your family be interested in this facility? Yes / No Does your family have any need for a School Holiday Program commencing immediately after the morning session? Yes / No Please Explain: If affordable school transport were made available would your family use this service? Does your employer pay your school fees? Yes / No Please explain and/or provide billing information: Is there any other information you would like to share with us?
Yes / No
Enrolment Contract •
I have read the Dili International School Family Information Booklet and 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 severe illness or 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 the Dili International School and will provide all requested documentation prior to my child commencing.
Parent/Guardian Name: DIS Representative
School Use: Discussion/Interview with management Placement interview/discussion with Area teacher or Coordinator Inspection of campus Copy of Security Policy given Playgroup/Preschool information given Fees Information 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 Not necessary Relevant class information, term overview, newsletters given Received enrolment form given to Principal/Class teacher Parents advised to bring hat, healthy snack, change of clothes, bag and all belongings clearly named Student details entered into: Enrolment Register Admin Phone: Email List: Class enrolled into: Name:
Date Commenced: Signed:
Published on Nov 1, 2010