Student Information - Child 1
Family Name:
Given Names:
Date of Birth:
Gender: MaleFemale
Address:
Country of Birth:
Ethnic Background:
Language(s) Spoken at Home:
Applying For:
Programs: Online Academy
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).
Student Information - Child 2
Family Name:
Given Names:
Date of Birth:
Gender: MaleFemale
Applying For:
Programs: Online Academy
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).
Student Information - Child 3
Family Name:
Given Names:
Date of Birth:
Gender: MaleFemale
Applying For:
Programs: Online Academy
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).
Student Information - Child 4
Family Name:
Given Names:
Date of Birth:
Gender: MaleFemale
Applying For:
Programs: Online Academy
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).
Social Media Permission
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.
Billing Address Each Parent/guardian is responsible for all accounts
Title:
Family Name:
Address:
Suburb:
Postcode:
State:
Email:
Mobile:
Declaration & Statement of Commitment
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)
