Registration Form

www.aia.vic.edu.au

PLEASE USE BLOCKED LETTERING

Full Name

Residential Address

Post Code

Postal Address

Occupation Country of Birth

Home Phone Mobile

Work Phone Email

Signature Date

FATHER/MALE GUARDIAN DETAILS

PARENT / GUARDIAN

Family Name

Given Name

To enter year level in the year Gender Male Female

Date of birth Country of birth

Religion Nationality

Present school / Kinder

Student lives with Both parents or Father only or Mother only Grandparents

Other please specify

Australian Citizen Yes No Permanent Resident Yes No Visa Number

STUDENT DETAILS

(INCLUDING OVERSEAS COUNTRIES)

(EG. YEAR 4)

Full Name

Residential Address

Post Code

Postal Address

Occupation Country of Birth

Home Phone Mobile

Work Phone Email

Signature Date

MOTHER/FEMALE GUARDIAN DETAILS

PARENT / GUARDIAN

OFFICE USE ONLY

RECEIPT NO.

DATE RECEIPT

STUDENT ID

DEBTOR ID

*Completed form and attached Birth Certificate must be returned to the School Registrar.

Registration Form

Names of other children at this Academy Year Level

(PLEASE, FILL IN IF APPLICABLE. EVEN IF CURRENTLY AWAITING ADMISSION)SIBLINGS AT AUSTRALIAN INTERNATIONAL ACADEMY

CURRENT SCHOOL CONTACT (AS PART OF THE ENROLMENT PROCESS THE STUDENTS CURRENT SCHOOL WILL BE CONTACTED)

School Name Contact

Position Phone

Postal Address

Contact Name Mobile

Relationship to Student

EMERGENCY CONTACT (OTHER THAN PARENTS)

A one-off Registration Fee of $110 is payable with the Registration form. This fee is non-refundable.Methods of payment: Cash (in person) By Phone Cheque (Payable to Australian International Academy) Credit Card (in person, surcharge apply)

PAYMENT DETAILS ENROLMENT GUARANTEE (EG)The EG is an interest free deposit of $1,000 per student that is paid prior to commencing at the Academy.The EG will be refunded on written request if /when; Student leaves the Academy. Student completes final school year. Student was asked to leave, the Academy.

DECLARATIONWe declare that all the information provided in this Registration form is true and correct as of the date of registration. We request that the above child be registered for enrolment at the Australian International Academy. We understand that we will be informed if and when a place becomes available. We are aware that the Registration fee is non-refundable. We will also advise the Australian International Academy of any change of address or contact details we may have.

Signature Date

Signature Date PARENT / GUARDIAN FEMALE

PARENT / GUARDIAN MALE

www.aia.vic.edu.au

OFFICE USE ONLY

DOB EVIDENCE

MEDICAL REPORTS

COURT ORDERS IMMUNISATION

EDUCATIONAL REPORT INTERVIEW OFFER