WESTERN REGION BANGLA SCHOOL - Enrolment Form 2023

Student Details:
Enrolment Year*
(Example: 2023)
Student Surname*
Student First Name*
Student Middle Name(s)
Student Date of Birth*

DayMonthYear
Date
Gender*

MaleFemale
Student Mainstream School
(Please, select from drop-down lists or, keep typing the school name to find it easily)
Student Mainstream School: (Alphabetical Order: A to L)
Student Mainstream School: (Alphabetical Order: M to Z)
Student Mainstream School Year Level*
(Please, select from drop-down lists)
Name of previous Community Language School:
Example: Western Region Bangla School
Residential Address*
Suburb*
Postcode*
(Example: 3000)
Student Residential Status:*

Australian Citizen/PRFull-fee paying international student
Parent Details:
Father
Full Name*
Home Phone
Mobile Phone*
E- mail*
example@example.com
Mother
Full Name*
Home Phone
Mobile Phone
E- mail*
example@example.com
Emergency Contact Details:

(Only If different from parent)
Emergency Contact Name
Relation to student
Emergency Contact Phone
Student Medical Information:
Does your child have any learning difficulty and/or medical condition (E.g. asthma, epilepsy, allergies etc.)?
*

YesNo
If yes, please specify and provide a detail medical care plan.
Permission to use Child's Photographs and Video:
Do you have permission to publish your child's photographs or video in WRBS & VBCF social media and other digital and print media?
*

YesNo
Parent/Guardian Declaration Agreement
*

I certify that the information provided on this form is true and correct and:
* Agree to the school’s terms and conditions of enrolment

* Authorise, where applicable, the Principal or teacher in charge (where the Principal

or teacher in charge is unable to contact me, or it is otherwise impractical to contact,

me to: (cross out any unacceptable statement)

* Consent to my child receiving such medical or surgical attention as may be deemed

administer first aid as necessary

* Administer such first aid as the Principal or staff member may judge to be reasonably
Fees:
Enrollment fee of $10 is mandatory,
but $10 for School Bag fee is optional.
(Please Submit/Upload the payment receipt if the payment made through Bank transfer)
Payment Options:*

Bank TransferOnline PaymentCash
Bank Transfer Details:
Account Name: Western Region Bangla School

BSB: 033 695

Account no.: 533 380
Payment via Paypal Gateway:
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WRBS Enrolment Fee
$10.00AUD

School Bag
$10.00AUD

Total

$0.00AUD
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The payment is ready! It will be completed once you submit the form.
Please, Upload the Receipt here: (pdf, jpg, jpeg, png)*
Cash: Name of the person (WRBS Authorized Person Only):*
Parent/Guardian Privacy Consent and Declaration:
I confirm that the information provided on this enrolment form is true and correct and I acknowledge and agree to the terms and conditions of enrollment accompanying this enrollment form. I consent to:

• the collection of my child’s health and personal information by the community
language school;
• the community language school disclosing my child’s personal information contained in
this enrolment form to the Department of Education and Training for data verification
and funding purposes;
• the Principal or teacher (where the Principal or teacher in charge is unable to contact
me) to administer such first aid to my child as the Principal or staff member may
consider to be reasonably necessary including disclosing personal and health
information to professional third parties in the event of a medical emergency.
Privacy Statement:
All the above collected information by WRBS about the students and their families will be kept private and only will be used following the DET’s standardized School’s Privacy Policy (https://www.education.vic.gov.au/Pages/schoolsprivacypolicy.aspx). Following the policy ensure WRBS is complying current privacy legislation and department policy.
Signature: Parents/Guardian's signature
*

FatherMotherGuardian
Signature

Clear
Date*

DayMonthYear
Date
Please verify that you are human*
Should be Empty:

Student Details:

Parent Details:

Father

Mother

Emergency Contact Details:

Student Medical Information:

Permission to use Child's Photographs and Video:

Parent/Guardian Declaration Agreement

Signature: Parents/Guardian's signature