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DerDieDas Inc Enrolment Form

PRIVACY NOTIFICATION - DerDieDas Inc. uses the enrolment form to collect personal information for the purpose of program
enrolment and statistical recording. The information will not be disclosed to any other party not directly involved with the provision of any DerDieDas Inc. programs, except by law. You can amend or correct information on request by contacting DerDieDas Inc.

Please complete the form below. For each child you wish to enrol, please complete a separate enrolment form.

If you have any questions, please contact us here.

For which group is the enrolment? *

Rappelkiste Pinguine (Beaumaris) - AU$130

Rappelkiste Pinguine (Beaumaris)- HALF TERM (4x) - AU$120

KigaFanten - AU$330

KigaNinchen - AU$210

KiGaMäuse - AU$210

Child Full Name

Birthday

Commencing school in year? (please use 01/01/XXXX)

Languages spoken at home: * Required

German

English

Do you speak any other languages at home?

Full name Parent / Guardian 1

Address Parent / Guardian 1

Email Parent / Guardian 1

Phone Parent / Guardian 1

Full Name Parent/ Guardian 2/ Alternative Emergency Contact

Address Parent/ Guardian 2/ Alternative Emergency Contact

Email Parent/ Guardian 2/ Alternative Emergency Contact

Phone Parent / Guardian 2 / Alternative Emergency Contact

Once your child is enrolled, are you happy to be added to the Group’s WhatsApp group (if there is one for your selected program) *

Yes

No

If yes, please provide phone number/s for WhatsApp Group:

Medical Conditions: If applicable, please provide an action plan endorsed by a medical practitioner before your child´s first session via the upload function below * Required

None

Asthma

Anaphylaxis

Allergic Reaction

Other

Is there anything else we should know about your child? (e.g. physical, behavioral or any other needs)

Upload Asthma Action Plan

Upload supported file (Max 15MB)

Upload Anaphylaxis Action Plan

Upload supported file (Max 15MB)

Upload Allergic Reaction Action Plan

Upload supported file (Max 15MB)

Upload any applicable file

Upload supported file (Max 15MB)

For KiGa ONLY: Are you bringing a sibling when volunteering? (if unsure, please tick Yes)

Yes

No

For KiGa ONLY: Indicate the dates your CHILD is NOT ATTENDING this term

For KiGa ONLY: Indicate the dates you are NOT AVAILABLE to volunteer

For KiGa ONLY: Indicate the dates you WOULD LIKE to volunteer

For KiGa ONLY: Please upload your valid Working With Children Check (if not available yet, use a screenshot of your application)

Upload WWCC

Upload supported file (Max 15MB)

For KiGa ONLY: Please indicate the expiry date of your WWCC

I declare that the information in this registration form is true and correct and undertake to immediately inform DerDieDas Inc. in the event of any change to this information.

In ticking this box, I declare that I have read, understood and agreed to theDerDieDas Terms and Conditions

Your Signature

Thanks for submitting your enrolment form!

Enroll Online: Sales Lead

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