DHS Country Week School Information Form "*" indicates required fields InstagramThis field is for validation purposes and should be left unchanged.School InformationFull School Name*Principal's Name*HOLA's Name*Country Week Coordinator's Name*Mobile Number*Country Week Coordinator - number of years attending Country week [including this year]*Total number of students attending Country Week*Total number of staff attending Country Week*Perth Team AccommodationResidence in Perth*Address*Phone Number*Coach and Manager DetailsIndicate the teams you have nominated and complete the Coach/Manager details* Badminton Basketball Boys Team 1 Basketball Boys Team 2 Basketball Girls Basketball Mixed Hockey Mixed Netball Team 1 Netball Team 2 Netball Team 3 Futsal Mixed Volleyball Mixed Name - Badminton Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Basketball Boys Team 1 Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Basketball Boys Team 2 Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Basketball Girls Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Basketball Mixed Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Hockey Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Netball Team 1 Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Netball Team 2 Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Netball Team 3 Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Futsal Coach* First Last Mobile Number*Number of years attending Country Week?*Name - Volleyball Coach* First Last Mobile Number*Number of years attending Country Week?*Other InformationEducation Region*South MetroNorth MetroGoldfieldsKimberleyMidwestPilbaraSouth WestWheatbeltUnknownEducation Sector* Department of Education AISWA CEWA School Type* Government Non-Government GenderNumber of students if known.Male*Female*Gender DiverseEthnicityNumber of students if known.Aboriginal and/or Torres Strait Islander*Cultural and/or Linguistic Diversity (CaLD)*Includes students who speak another language at home; where English is their second language; whose parents were born overseas.DisabilityStudents With A DisabilityIf known this includes students with a diagnosed physical, intellectual, sensory or social & emotional disability.Photo/Video PermissionsDo you have any Students attending Country Week who DO NOT consent to be photographed?* Yes No Please list the relevant team/s for any applicable non-consenting student/s*School CaptainsBoyGirl Add RemovePlease provide 2 Captains Names
