<p> Child x  $150 Adult x  $200 Families: $50 discount for every subsequent enrolment TTL $______</p><p>STUDENT DETAILS 2017 TTL CASH  CHEQUE  - PAID  INITIALS ___ __ Surname:</p><p>Given Name:</p><p>Sex (tick):  Male  Female Date of Birth: (dd-mm-yyyy) ______/ ______/ ______</p><p>HOME ADDRESS:</p><p>Name of parent/s or guardian (NA for adult students)</p><p>Email</p><p>Street Address</p><p>Suburb: Postcode:</p><p>State: Phone Number:</p><p>DEMOGRAPHIC DETAILS – PLEASE ONLY COMPLETE WHAT IS APPLICABLE FOR THE STUDENT</p><p>Name of current school:</p><p>Student’s current grade:</p><p>Has the student ever attended school in DK?</p><p>Has the student received Danish lessons previously?</p><p>Please describe the student’s ability in Danish: (ie fluent in verbal, beginner in written etc)</p><p>What is the student’s connection to Denmark?</p><p>What are you and/or the student expecting to get out of attending Danish School?</p><p>1 MEDICAL DETAILS</p><p>MEDICAL CONDITION DETAILS:</p><p>Does the student suffer from any of the Hearing:  Yes  No Vision  Yes  No following impairments? Speech:  Yes  No Mobility:  Yes  No Does the student suffer from Asthma? If No, please go to the Other Medical Conditions section  Yes  No</p><p>ASTHMA MEDICAL CONDITION DETAILS: Answer the following questions ONLY if the student suffers from any asthma medical conditions. Please indicate if the student suffers from any of the If the student displays any of these symptoms please: following symptoms:  Cough Inform Doctor  Yes  No  Difficulty Breathing Inform Emergency Contact  Yes  No  Wheeze Administer Medication  Yes  No  Exhibits symptoms after exertion Other Medical Action  Yes  No  Tight Chest If yes, please specify:</p><p>Does the student take medication?  Yes  No Name of medication taken:</p><p>Medication is usually administered by:  Student  Nurse  Teacher  Other</p><p>OTHER MEDICAL CONDITIONS (More copies of the other medical condition forms are available on request from the school.) Does the student have any other medical condition?  Yes  No</p><p>If yes, please specify:</p><p>Symptoms:</p><p>From time to time we will take photos of students while they are participating in school activities. Do you to consent to the student being in any such photos, and for the school committee to use them for promotional purposes (including Social Media)? Yes □ No □</p><p>I understand and accept that DSDU is a Victorian Child Safe Organisation and that carers/parents/guardians must respect the policies that falls under the DSDS’s Child Safe Code of Conduct which is in place to protect all children enrolled in the school. Yes □ </p><p>Signature of Parent/Guardian/Student: Date: _____ / _____ / ______</p><p>2</p>