Primary Aboriginal Dance Workshop – application form

Important information

In the event of injury, no personal injury insurance cover is provided by the NSW Department of Education for students in relation to school sporting activities, physical education lessons or any other school activity. The department’s public liability cover is fault-based and limited to breaches by the department of its duty of care to students that may result in claims for compensation.

Parents/carers are advised to assess the level and extent of their child’s involvement in the activity when deciding whether additional insurance cover is required prior to their child’s involvement in the program. Personal accident insurance cover is available through normal retail insurance outlets.

Privacy notice

The information requested in this note is being collected by the NSW Department of Education. The department will use the information in connection with your student's participation in this event for the following purposes:

  1. administration;
  2. communication with parents/carers; and
  3. for the health, safety and welfare of your student.

The department might share the information requested in this note with health care providers in the event that your student requires urgent medical attention. All personal information will be held securely and disposed of securely when no longer needed.

You have the right to access and correct the information you provide in this note. If you wish to do so, please contact The Arts Unit on 02 8512 1100 Locked Bag 1500, Petersham NSW 2049 

Specific privacy information

The department will use information about your student's

  • Aboriginal or Torres Strait Islander status for the purpose of implementing its Aboriginal Education Policy.
  • Identified additional support information to ensure appropriate learning adjustments are in place.

The provision of Aboriginal/Torres Strait Islander status or gender status is voluntary, and not providing either of them will not impact on your student's participation. All other additional support information requested in this form is voluntary.

School information

Contact teacher information

Teaching position

Workshop details

How will your students be attending the workshop?

Participating students

Is the attending teacher information the same as the contact teacher details above?

Attending teacher contact information

Teaching position

Permissions

I acknowledge that this event/activity is required to be held in accordance with any current NSW Health COVID-19 Public Health Orders and the NSW Department of Education’s policies and procedures. I acknowledge and accept that there is a risk that my child may be exposed to COVID-19 whilst attending and participating at this event. I confirm that my child will not attend if displaying any symptoms of illness, and/or if directed to isolate under public health orders.
 (only select if applicable) 
Behaviour code for students
Please note - a maximum of 2 students per school are permitted to attend without a teacher however, you will be required to obtain approval from the program coordinator prior to submitting your application for any unaccompanied students. Please contact [email protected] to discuss individual applicants.

Unaccompanied student details

Student 1

Please select the school year you are currently in.
Please complete the unaccompanied medical form (DOCX 22.09KB) and upload as part of your application.
One file only.
16 MB limit.
Allowed types: jpg, jpeg, png, pict, txt, rtf, html, pdf, doc, docx, zip.
Does the student have any medical conditions that require a medical plan?
Please supply the student medical action plan by uploading now or via email it to [email protected]
One file only.
16 MB limit.
Allowed types: jpg, jpeg, png, pict, psd, txt, rtf, html, pdf, doc, docx, zip.
Are there any special circumstances about the student that the program coordinator should know prior to enrolment?
Additional learning and support needs, including disability
Does the student require support for participation because of disability?
Is there anything that you do or modify at home that may help us to meet the student’s educational needs?
Please indicate any learning adjustments that may be required to allow the student to participate in this program? (complete only if applicable)
For example, speaking and/or listening
For example, hygiene, mealtimes and/or health care needs social support to engage safely with others
Please indicate if the student has any of the following
Is there a documented plan to support the student’s additional learning needs at school?
Please upload the student's plan to support additional learning needs, or email [email protected]
One file only.
16 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Method of student transport to and from daily workshops
One file only.
16 MB limit.
Allowed types: gif, jpg, jpeg, png.
The student and parent/caregiver  has read and understood Student Behaviour Code. They understand that there will be consequences if the student does not behave appropriately. In these cases, action will be taken at The Arts Unit and/or the student's school and may include withdrawal from this and future activities. 
I acknowledge that this event/activity is required to be held in accordance with any current NSW Health COVID-19 Public Health Orders and the NSW Department of Education’s policies and procedures. I acknowledge and accept that there is a risk that my child may be exposed to COVID-19 whilst attending and participating at this event. I confirm that my child will not attend if displaying any symptoms of illness, and/or if directed to isolate under public health orders.
I have emailed the program coordinator Ashley Napoeloni the names of any students who do not have permission to publish.
Has the request for unaccompanied students been approved in writing by the Program Coordinator – Ashley Napoleoni?

Student 2

Please select the school year you are currently in.
Please complete the unaccompanied medical form (DOCX 22.09KB) and upload as part of your application.
One file only.
16 MB limit.
Allowed types: jpg, jpeg, png, pict, psd, txt, rtf, html, pdf, doc, docx, zip.
Does the student have any medical conditions that require a medical plan?
Please supply the student medical action plan by uploading now or via email it to [email protected]
One file only.
16 MB limit.
Allowed types: jpg, jpeg, png, pict, psd, txt, rtf, html, pdf, doc, docx, zip.
Are there any special circumstances about the student that the program coordinator should know prior to enrolment?
Additional learning and support needs, including disability
Does the student require support for participation because of disability?
Is there anything that you do or modify at home that may help us to meet the student’s educational needs?
Please indicate any learning adjustments that may be required to allow the student to participate in this program? (complete only if applicable)
For example, speaking and/or listening
For example, hygiene, mealtimes and/or health care needs social support to engage safely with others
Please indicate if the student has any of the following
Is there a documented plan to support the student’s additional learning needs at school?
Please upload the student's plan to support additional learning needs, or email [email protected]
One file only.
16 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Method of student transport to and from daily workshops
One file only.
16 MB limit.
Allowed types: gif, jpg, jpeg, png.
The student and parent/caregiver has read and understood Student Behaviour Code. They understand that there will be consequences if the student does not behave appropriately. In these cases, action will be taken at The Arts Unit and/or the student's school and may include withdrawal from this and future activities. 
I acknowledge that this event/activity is required to be held in accordance with any current NSW Health COVID-19 Public Health Orders and the NSW Department of Education’s policies and procedures. I acknowledge and accept that there is a risk that my child may be exposed to COVID-19 whilst attending and participating at this event. I confirm that my child will not attend if displaying any symptoms of illness, and/or if directed to isolate under public health orders.
I have emailed the program coordinator Ashley Napoeloni the names of any students who do not have permission to publish.
Has the request for unaccompanied students been approved in writing by the Program Coordinator – Ashley Napoleoni?

SAM and Payment Information

$0
I understand that the school will be charged the above fee for participation in this program. Fees are processed as a direct debit via an Intercompany Journal (previously Sundry Tax) after the first session.
School Administrative Manager

Principal information