Application for Enrolment

1

Student Information

Student details, enrolment year, residency, and language information.

Name * Surname * Address * Suburb * Post code * Date of birth *

Gender * M F

Nationality Application for entry into Year * Calendar year * Present school Current grade Country of birth Place of birth Australian permanent resident Visa type / number Visa expiry Permission to view visa documents through VEVO

Aboriginal and Torres Strait Islander status Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander Neither

Student's first language

2

Family Information

Mother/guardian, father/guardian, custody, and alternate guardian details.

Mother / Guardian 1

Relationship to student * Title First name * Surname * Address Suburb Post code Country of birth Nationality Country of citizenship Religion Language spoken at home Home phone Work phone Mobile * Email * Occupation Employer

Father / Guardian 2

Relationship to student Title First name Surname Address Suburb Post code Country of birth Nationality Country of citizenship Religion Language spoken at home Home phone Work phone Mobile Email Occupation Employer

Name of person/s with legal guardianship of the student Parenting or Family Law Court Orders in place Who the child lives with most of the time Balanced care arrangement Other custody/guardianship notes

Alternate Parent / Guardian Details

Title First name Surname Relationship to student Address Suburb Post code Home phone Work phone Mobile Email Occupation Employer

3

Siblings, Emergency Contacts and Government Information

Sibling enrolments, emergency contacts, parent education, qualifications, and occupation group.

Siblings being enrolled or currently enrolled

Full name Date of birth Calendar year of entry School year of entry

Emergency Contact 1

Name Telephone Address Relationship to student

Emergency Contact 2

Name Telephone Address Relationship to student

Occupation group - Parent / Guardian 1 Occupation group - Parent / Guardian 2

4

Student Individual Needs and Medical Information

Disability, learning support, medical, Medicare, consent, transport, and care information.

Other disability or support need Diagnosed by Date of diagnosis Additional information

Medical conditions Allergies Asthma Coeliac Eczema Heart disorder

Other medical condition Prescribed medicines at school Medical details and medication information Medical Action Plan required Medicare number Medicare expiry Position on card Permission to administer Panadol Ambulance cover Doctor's name Name of medical centre Doctor suburb Doctor phone number Permission to call doctor in emergency Photographic/video consent

Bus service required Baldivis Bertram Karnup Kwinana/Rockingham Oakford Warnbro

Permission to meet with School Social Worker Is your child toilet independent If not toilet independent, please explain

5

Financial Details, Terms and Documents

Fee responsibility, application terms, signatures, and required document checklist.

Financial Details 1

Name * Relationship to student * Responsible for what % of fees Email * Postal address Suburb Post code Home phone Mobile phone

Financial Details 2

Name Relationship to student Responsible for what % of fees Email Postal address Suburb Post code Home phone Mobile phone

Mother / Guardian 1 signature name Mother / Guardian 1 signature date Father / Guardian 2 signature name Father / Guardian 2 signature date

Student document checklist Birth certificate Visa information and citizenship certificate, if applicable Immunisation history statement Latest school reports All NAPLAN reports Medical/disability specialist reports Medical action plan, if applicable

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Privacy and declaration

The information in this application will be used to assess enrolment, contact guardians, support student welfare, and manage admissions records.

Applicant / guardian name * Date *

Review your application

Check the key details below before submitting.