Given Name Sample Clauses

Given Name. Nationality............................................................ [ ] Male [ ] Female Date of Birth !.! / ....... /....... Home Country Contact Details Address...................................................................................................................... Telephone ............................................................Mobile............................................... Fax ............................................................Email......................................................... Australian Contact Details Address...................................................................................................................... Telephone ............................................................Mobile............................................... Fax ............................................................Email.........................................................

Given Name. Gender [ ] Male [ ] Female [ ] Other Date of Birth .............. / ............./............. Nationality................................................................

Given Name. Address ............................................................................................................................................................ Phone (Home) ................................... (Work) ................................. (Mobile)........................................... To best serve the needs of students the College should be made aware of any conditions that could impact on your son's learning. Does your son have any special achievements or talents? ❑ Yes ❑ No If yes please provide further information or attach supporting documentation ........................................................... ........................................................................................................................................................................ Does your son have any of the following? Dyslexia ❑ Yes ❑ No Asperger Syndrome or Autism ❑ Yes ❑ No Attention Deficit Disorder (with/without hyperactivity (ADD/ADHD) ❑ Yes ❑ No Intellectual disability ❑ Yes ❑ No Language disorder ❑ Yes ❑ No Emotional or behavioural disturbances ❑ Yes ❑ No Borderline intellectual disability ❑ Yes ❑ No PHYSICAL IMPAIRMENTS Physical disability ❑ Yes ❑ No Vision impairment ❑ Yes ❑ No Hearing impairment ❑ Yes ❑ No Are there any reports that provide further information? E.g. psychological, speech pathology, medical etc ❑ Yes ❑ No If yes, please provide a copy with this application. Your son may be assessed by the College Psychologist. You will be informed if this is to happen. The results of this assessment or previous reports may allow the College to source assistance from outside organisations. Please sign the release form below so that reports can be passed on and extra help accessed for your son if he is eligible. Does your son suffer from any of the following conditions? Is your child under a health care plan for Asthma? ❑ Yes ❑ No (if yes please provide a copy of the Health Care plan from your doctor) Severe Allergy (E.g. Bee Sting) ❑ Yes ❑ No Joint Disorder (E.g. Arthritis) ❑ Yes ❑ No Ear Disorder (E.g. Drainage Tubes) ❑ Yes ❑ No Incontinence ❑ Yes ❑ No Medication usually taken at school ❑ Yes ❑ No Diabetes ❑ Yes ❑ No Heart Disorder ❑ Yes ❑ No Skin Condition (E.g. Dermatitis) ❑ Yes ❑ No Swallowing/Choking difficulties ❑ Yes ❑ No Communication Difficulties ❑ Yes ❑ No