Student Enrolment Application Form

Student Enrolment Application Form
Student Enrolment Application Form Thank you for your interest in our school. You can save this form at any time to resume later, simply by clicking the 'save' button and entering your email. Please click 'Next' to continue.

Section 3: GUARDIANSHIP
Please identify the legal guardian(s) of the student(s)
Caregiver 1Caregiver 2Other (please specify)
Are there any legally binding parenting or restraining orders, or other conditions we should be aware of?
NoYes (please specify)
Caseworker's name (if applicable)
TitleFirst NameLast Name
Department
Branch
Office address
Street Address
Street Address Line 2
SuburbState / Territory
PostcodeCountry
Phone number
Email
example@example.com

Section 5: MEDICAL INFORMATION
Emergency contacts (other than caregivers)
Contact 1 name
TitleFirst NameLast Name
Phone number
Relationship to child
Contact 2 name
TitleFirst NameLast Name
Phone number
Relationship to child
Health providers
Family doctor
Medical clinic
Phone number
Medicare card number
Medicare card expiry date
Medicare individual reference number for {name} (number to left of name)
Medicare individual reference number for {name179}
Do you have ambulance cover?
YesNo
Private health fund name
If applicable
Private health fund policy number
Immunisation Government regulations require schools to obtain immunisation records at the time of enrolment and keep records. School Health Services has to notified of children who are not immunised. Only an Australian Immunisation Register (AIR) Immunisation Status Report can be accepted.
Do you have an AIR Immunisation Status Report for all students on this form?
YesNo

Section 1: Student information