{"id":1098,"date":"2021-05-12T01:09:52","date_gmt":"2021-05-12T01:09:52","guid":{"rendered":"http:\/\/islamicsocietyballarat.org\/?page_id=1098"},"modified":"2021-05-12T02:26:04","modified_gmt":"2021-05-12T02:26:04","slug":"bilc-enrollment-form","status":"publish","type":"page","link":"https:\/\/islamicsocietyballarat.org\/index.php\/bilc-enrollment-form\/","title":{"rendered":"BILC Enrollment Form"},"content":{"rendered":"\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1097-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1097\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1098#wpcf7-f1097-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1097\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1097-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"wpcf7-turnstile cf-turnstile\" data-sitekey=\"0x4AAAAAABl9i5xZN5iBWTL3\" data-response-field-name=\"_wpcf7_turnstile_response\"><\/div>\n\n<p><label> Are you a new or returning student?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"new_student\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"new_student\" value=\"New Student\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">New Student<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"new_student\" value=\"Returning Student\" \/><span class=\"wpcf7-list-item-label\">Returning Student<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h3>Student Information\n<\/h3>\n<p><label>Personal information about the student enrolling<\/label>\n<\/p>\n<p><label> Full Name * <span class=\"wpcf7-form-control-wrap\" data-name=\"student-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"student-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Date of Birth * <span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span> <\/label>\n<\/p>\n<p><label> Gender *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"gender\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Male\">Male<\/option><option value=\"Female\">Female<\/option><\/select><\/span> <\/label>\n<\/p>\n<h5>Address\n<\/h5>\n<p><label> Street Address * <span class=\"wpcf7-form-control-wrap\" data-name=\"street-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"street-address\" \/><\/span> <\/label><br \/>\n<label> Street Address Line 2 <span class=\"wpcf7-form-control-wrap\" data-name=\"street-address-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"street-address-2\" \/><\/span> <\/label><br \/>\n<label> Suburb * <span class=\"wpcf7-form-control-wrap\" data-name=\"suburb\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"suburb\" \/><\/span> <\/label><br \/>\n<label> State *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"state\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"state\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"VIC\">VIC<\/option><option value=\"NSW\">NSW<\/option><option value=\"NT\">NT<\/option><option value=\"SA\">SA<\/option><option value=\"WA\">WA<\/option><option value=\"TAS\">TAS<\/option><option value=\"OLD\">OLD<\/option><option value=\"ACT\">ACT<\/option><\/select><\/span> <\/label><br \/>\n<label> Post Code * <span class=\"wpcf7-form-control-wrap\" data-name=\"post-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"post-code\" \/><\/span> <\/label><br \/>\n<hr \/>\n<\/p>\n<p><label> Name of Academic School * <span class=\"wpcf7-form-control-wrap\" data-name=\"school\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"school\" \/><\/span> <\/label><br \/>\n<label> Academic Year\/Grade * <span class=\"wpcf7-form-control-wrap\" data-name=\"grade\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"grade\" \/><\/span> <\/label>\n<\/p>\n<h5>Medical Conditions\n<\/h5>\n<p><label> Do you have any diagnosed medical conditions? * <span class=\"wpcf7-form-control-wrap\" data-name=\"medical-conditions\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"medical-conditions\"><\/textarea><\/span> <\/label><br \/>\n<label> Do you have any special dietary requirements? * <span class=\"wpcf7-form-control-wrap\" data-name=\"dietary-requirements\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"dietary-requirements\"><\/textarea><\/span> <\/label><br \/>\n<label> Medicare Number * <span class=\"wpcf7-form-control-wrap\" data-name=\"medicare\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"medicare\" \/><\/span> <\/label>\n<\/p>\n<h3>Parent \/ Guardian \/ Next of Kin Details (1)\n<\/h3>\n<p><i>Information about a parent\/guardian\/next of kin for the student (must be aged 18 years and older)<\/i><br \/>\n<label> Full Name * <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p1-name\" \/><\/span> <\/label><br \/>\n<label> Relationship to student * <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-relation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p1-relation\" \/><\/span> <\/label><br \/>\n<label> Mobile Number * <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"p1-mobile\" \/><\/span> <\/label><br \/>\n<label> Phone Number <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"p1-phone\" \/><\/span> <\/label><br \/>\n<label> Email * <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"p1-email\" \/><\/span> <\/label>\n<\/p>\n<h5>Address\n<\/h5>\n<p><label> Street Address * <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-street-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p1-street-address\" \/><\/span> <\/label><br \/>\n<label> Street Address Line 2 <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-street-address-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p1-street-address-2\" \/><\/span> <\/label><br \/>\n<label> Suburb * <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-suburb\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p1-suburb\" \/><\/span> <\/label><br \/>\n<label> State *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"p1-state\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"p1-state\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"VIC\">VIC<\/option><option value=\"NSW\">NSW<\/option><option value=\"NT\">NT<\/option><option value=\"SA\">SA<\/option><option value=\"WA\">WA<\/option><option value=\"TAS\">TAS<\/option><option value=\"OLD\">OLD<\/option><option value=\"ACT\">ACT<\/option><\/select><\/span> <\/label><br \/>\n<label> Post Code * <span class=\"wpcf7-form-control-wrap\" data-name=\"p1-post-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p1-post-code\" \/><\/span> <\/label>\n<\/p>\n<h3>Parent \/ Guardian \/ Next of Kin Details (2)\n<\/h3>\n<p><i>Information about a parent\/guardian\/next of kin for the student (must be aged 18 years and older)<\/i><br \/>\n<label> Full Name * <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p2-name\" \/><\/span> <\/label><br \/>\n<label> Relationship to student * <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-relation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p2-relation\" \/><\/span> <\/label><br \/>\n<label> Mobile Number * <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"p2-mobile\" \/><\/span> <\/label><br \/>\n<label> Phone Number <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"p2-phone\" \/><\/span> <\/label><br \/>\n<label> Email * <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"p2-email\" \/><\/span> <\/label>\n<\/p>\n<h5>Address\n<\/h5>\n<p><label> Street Address * <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-street-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p2-street-address\" \/><\/span> <\/label><br \/>\n<label> Street Address Line 2 <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-street-address-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p2-street-address-2\" \/><\/span> <\/label><br \/>\n<label> Suburb * <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-suburb\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p2-suburb\" \/><\/span> <\/label><br \/>\n<label> State *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"p2-state\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"p2-state\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"VIC\">VIC<\/option><option value=\"NSW\">NSW<\/option><option value=\"NT\">NT<\/option><option value=\"SA\">SA<\/option><option value=\"WA\">WA<\/option><option value=\"TAS\">TAS<\/option><option value=\"OLD\">OLD<\/option><option value=\"ACT\">ACT<\/option><\/select><\/span> <\/label><br \/>\n<label> Post Code * <span class=\"wpcf7-form-control-wrap\" data-name=\"p2-post-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p2-post-code\" \/><\/span> <\/label>\n<\/p>\n<h3>Photography & Film Permission\n<\/h3>\n<p><i>The School may take photos\/videos of students for purposes of documentation, assessment and marketing. These images may be used for print, online and social media activities. The student\u2019s image will only be used after a formal written consent has been obtained from the parents\/guardians<\/i>\n<\/p>\n<p><label> Photography & Filming Permission * <span class=\"wpcf7-form-control-wrap\" data-name=\"photo-permission\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"photo-permission\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Yes, I give consent for photos\/videos\">Yes, I give consent for photos\/videos<\/option><option value=\"No, I do not give consent for photos\/videos\">No, I do not give consent for photos\/videos<\/option><\/select><\/span> <\/label>\n<\/p>\n<h3>Declaration\n<\/h3>\n<p><i>I agree that the above information is correct and I will inform Ballarat Islamic School if there are<br \/>\nany changes to above mentioned details<\/i>\n<\/p>\n<p><label> To be completed by a parent \/ legal guardian * <\/label><label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"agree-info-correct\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"agree-info-correct[]\" value=\"I agree that the above information is correct\" \/><span class=\"wpcf7-list-item-label\">I agree that the above information is correct<\/span><\/label><\/span><\/span><\/span><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/><\/label>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"0\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-no-sidebar.php","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-1098","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/pages\/1098","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/comments?post=1098"}],"version-history":[{"count":1,"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/pages\/1098\/revisions"}],"predecessor-version":[{"id":1099,"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/pages\/1098\/revisions\/1099"}],"wp:attachment":[{"href":"https:\/\/islamicsocietyballarat.org\/index.php\/wp-json\/wp\/v2\/media?parent=1098"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}