1. HAMPTON PARK COMMUNITY HOUSE 16-20 Stuart Avenue HAMPTON PARK VIC 3976 Phone: 03 9799 0708Fax: 03 9799 4016 Student Enrolment and Information Student No. _______ Course Name: …………………………………………………… Title:………….First Name:……………………………......Surname:…………………………................. Gender: Male/FemaleDate of Birth…….. /........ /…..... Address:………………………………………………………………………………………………………. Suburb:………………………………………. State:……………………….Postcode:…………………… Postal address:............................................................................................................................. Phone (Bus):……………………………….. Phone (Home):……………………………………………. Mobile:………………………………………. Email:………………………………………………………. Emergency Contact:………………………………………Contact No:…………………………………… Country of Birth:…………………………………. Language Spoken:……………………………………. How well do you speak English? (Please circle one) 1 Very Well2 Well 3 Not Well 4 Not at All Concession Type:………………………….. Concession No.:…………………………………………… Exp. Date:……./……./……. Where did you learn about this course?(Please circle one) Program leaflet Newspaper Friend Notice BoardOther……………….. Are you of Koorie or Torres Strait Islander origin? (Please circle one) NoYes – AboriginalYes – Torres Strait Islander Do you have a disability, impairment or long-term condition? (Please circle one) Yes / No (If you say yes to this question you may still join the activity) Hearing/Deaf PhysicalIntellectualLearning Mental Illness Acquired Brain ImpairmentVisionMedical ConditionOther...………………… What is your highest completed school level? (Please circle one level) Year 12Year 11Year 10Year 9 or equivalentYear 8 or below Did not go to school Year completed school.................................. Do you have tertiary level qualifications? (Please circle one) Yes / No If yes, what are they? …………………………………………………..

2. CHILDCARE Do you require childcare while in class? Has your child/ren been booked into Childcare? Yes/No Childcare is available during class times for our students, in our purpose built facility. Booking is essential as there are limited places available. Fees are at a reduced rate for students which is to be paid on the day. PAYMENT OF CLASSES Missed Classes: All missed classes must be paid for regardless of any absences Night Classes: Full payment is required on booking Day Classes: On booking we require full course payment OR arrangements can be made to pay fees in weekly instalments By Mail: Indicate the course and time, include participant name, phone number and address with the full fee Please phone the day before your class to confirm details. Should a course be cancelled due to lack of participants, fees will be refunded (otherwise deposits and course fees are not refundable). IMPORTANT : I have read and understand the Houses Enrolment and Refund Policy Signature …………………………………………………. Date ……../……../………. The Hampton Park Community House office hours are 9am to 3pm Monday, Tuesday, Thursday and Friday. Wednesdays office hours are 9am to 6.30pm. We are closed during school holidays and Public Holidays. All users of the Hampton Park Community House are invited to become Members. This Fee is $3.00 annually. The Hampton Park Community House is required to provide the Victorian Government, through Skills Victoria, with student and training activity data which may include information I provide in this enrolment form. Information is required to be provided in accordance with the Victorian VET Student Statistical Collection Guidelines (which are available at www.skills.vic.gov.au/corporate/statistics/submit_data). Skills Victoria may use the information provided to it for planning, administration, policy development, program evaluation, resource allocation, reporting and/or research activities. For these and other lawful purposes, Skills Victoria may also disclose information to its consultants, advisors, other governments agencies, professional bodies and/or other organisations.www.skills.vic.gov.au/corporate/statistics/submit_data Serverdocs/general house/house forms/2010enrolment and info form.ppt Employment Status (please circle the category that best fits your current status) 01 Full time employee05 Employed - Unpaid worker in family 02 Part time employee06 Unemployed – seeking full time work 03 Self employed – no employees07 Unemployed – seeking part time work 04 Employer08 No employed – not seeking work or retired Why have you chosen this course? (Please circle one) 01 To get a job06 It was a requirement of my job 02 To develop my existing business07 I want extra skills for my job 03 To start my own business08 To get into another course of study 04 To start a different career11 Other reasons 05 To get a better job or promotion12 Personal interest or self development