Discover Our Learning Environment and Creative Approach
Family Name:
Given Names:
Date of Birth:
Gender: MaleFemale
Address:
Country of Birth:
Ethnic Background:
Language(s) Spoken at Home:
Applying For:
Location: Georges HallCampbelltown
Programs: Homeschool 1-Day ProgramHomeschool 3-Day ProgramAfter-School Tuition
Quran and Arabic addon with Homeschool 3 day program
Which subjects specifically does your child need help with? How many days per week? 12 How many sessions per day? 1 or 2 12 Note: 1 hour per KLA (eg: one hour English, one hour maths)
Levels: KindyStage 1Stage 2Stage 3Stage 4Stage 5
Current School:
Current Grade:
Please list any special circumstances of which Atheera Education should be made aware. (e.g physical/intellectual/emotional/learning difficulties, behavioural challenges, anxiety, ADHD, autism, gifts/talents. Please provide appropriate reports/ assessments of such circumstances if applicable).
Add New ChildDelete Above Child
I give Atheera permission to use my child/ren’s photos on all our social media platforms YesNo
With acknowledging and granting permission for Atheera to use your child/ren’s photo it will be on social media platforms, promotional material but not limited to these specifics mentioned.
Child lives with: Both ParentsMotherFatherGuardian
Are there any Custody restrictions? NoYes ( Please attach appropriate documents )
Notes/Information about custody restrictions:
Father Full Name:
Suburb:
Postcode:
Mobile:
Email:
Mother Full Name:
Medical Card Number:
Ref No:
Name of Family Doctor:
Phone:
Asthma Action PlanAnaphylaxis Action Plan
Please nominate two people who may be contacted in the event of an emergency, when parents cannot be contacted. Ideally, the contact people should be those who live in close proximity to Atheera.
Emergency Contact 1
Contact Name:
Relationship To Child:
Mobile Phone:
Emergency Contact 2
Title:
State:
To be completed and signed by both parents/guardians unless otherwise agreed to by Atheera in writing.
I/We certify that the above information given herein by me/us is correct. I/We understand, have read and understood and agree to be bound by the Conditions of Enrolment (CoE) I/We understand, have read and understood and agree to be bound by the Release Agreement I/We agree to be jointly liable for payment of all fees, costs and charges as set out in the CoE. I/We also undertake to assist my/our child in upholding the ethos of Atheera and agree to co-operate with Atheera’s management in supporting their rules and regulations.
Father’s Signature
Mother’s Signature
Date
Disclaimer: Whole Term Commitments are required. REFUNDS DO NOT APPLY (Refer to the Conditions of Enrolment (CoE) Agreement)
$50 per child for core 3 Day Program
$50 per child for 1 Day Program
$50 for After School Tuition
$0
