Offer of Enrolment: Request for Information Form

Student Details

Surname:* Please enter the child surname

Entry year (YYYY):* Which year will the child start school

First name/s:* Please enter the child

Preferred first name: Please enter the child preferred first name

Date of birth:* Enter the child

Entry level/grade:*

Gender:*

What is the child

Religion: Which religion does the child follow

Birth Certificate Upload* Birth Certificate Upload

Home Address of Student

Street number and name:* Where does the child live.

Suburb:* What suburb does the child live in

Postcode:* What postcode does the child live in

Home phone:* Best contact number for a parent/guardian

Emergency Contact - Other Than Parent/Guardian

Emergency Contact Details

Name of 1st emergency contact:* Name of first contact:

Relationship to child:* What is this contacts relationship to the child

Mobile:* What is this contact

Home Phone What is this contact home phone number

Name of 2nd emergency contact:* Alternative emergency contact name

Relationship to child:* What is this contacts relationship to the child

Mobile:* What is this contact

Home phone: What is this contact home phone number (If applicable).

Previous School/Preschool Permission

Name and address of previous school/preschool:* Name and address of previous school/preschool

I/We give permission for the school to contact the previous school or preschool and to gather relevant reports and information to support educational planning, in line with the Privacy Policy (please refer to the School website for this policy) (If no, please contact the school to discuss this matter further):* - required

Yes

Does the student or their parent(s)/guardian(s) speak a language other than English at home? Note: Record all languages spoken.

Student* - required

No (English only)

Yes (Other - please specify all languages)

Parent A/Guardian 1* - required

No (English only)

Yes (Other - please specify all languages)

Parent B/Guardian 2* - required

No (English only)

Yes (Other - please specify all languages)

Medical Information

Doctor's name* Doctor's name

Street number and name* Please enter doctor's street number and name

Suburb* Please enter doctor

Postcode* Please enter doctor's postcode

Phone* Please enter doctor's phone number

Medicare number* What is your medicare number

Ref number* What number is the student listed on your medicare card

Expiry Date*

Ambulance cover* - required

Yes

In the event of an emergency an ambulance will be called if required.

Medical condition: Please specify any relevant medical conditions for the student, e.g. asthma, diabetes, anaphylaxis, and/or any medications prescribed for the student. A Medical Management Plan signed by a relevant medical practitioner (doctor/nurse) will be required for each of the medical conditions listed.

Please list specific details for any known allergies that do not lead to anaphylaxis, e.g. hay fever, rye grass, animal fur.

Has the student been diagnosed as being at risk of anaphylaxis?* - required

Yes

If yes, does the student have an EpiPen?* - required

Yes

Does the student have an EpiPen

Additional Medical Management Plans

Yes

Please provide all required information to allow us to meet our duty of care obligations and facilitate the smooth transition of your child into our school. It will assist the school to implement appropriate adjustments and strategies to meet the particular needs of your child. If the information is not provided or is incomplete, incorrect or misleading, current or ongoing enrolment may be reviewed.

Additional Needs

Is your child eligible or currently receiving National Disability Insurance Scheme (NDIS) support?* - required

Yes

Have you attached all relevant information/reports?* - required

Yes

Government Requirement

Parent A

Parent A/Guardian 1

Surname* Parent A surname

Title: (e.g. Mr/Mrs/Ms)*

First Name* Parent A first name

Address* Parent A

Home phone Parent A's home phone

Work phone Parent A's work phone

Mobile* Parent A

SMS messaging: (for emergency and reminder purposes)* - required

Yes

SMS messaging: (for emergency and reminder purposes)

Email* Email

Review link containing occupation index before selecting an occupation

Occupation*

What is the occupation group? (select from list of parental occupation groups in the School Family Occupation Index)*

What is the occupation group? (select from list of parental occupation groups in the School Family Occupation Index)

Religion

Nationality (Ethnicity if not born in Australia)

Country of birth*

Country of birth

What is the highest year of primary or secondary school Parent A/Guardian 1 has completed?*

Persons who have never attended secondary school, tick

What is the level of the highest qualification Parent A/Guardian 1 has completed?*

What is the level of the highest qualification Parent A/Guardian 1 has completed?

Parent B

Parent B/Guardian 2

Surname Parent A surname

Title: (e.g. Mr/Mrs/Ms)

First Name Parent A first name

Address Parent A's Address

Home phone Parent A's home phone

Work phone Parent A's work phone

Mobile Parent A

SMS messaging: (for emergency and reminder purposes)

Yes

SMS messaging: (for emergency and reminder purposes)

Email* Email

Occupation

What is the occupation group? (select from list of parental occupation groups in the School Family Occupation Index)

Religion

Nationality (Ethnicity if not born in Australia)

Country of birth

What is the highest year of primary or secondary school Parent B/Guardian 2 has completed?*

Persons who have never attended secondary school, tick

What is the level of the highest qualification Parent B/Guardian 2 has completed?*

What is the level of the highest qualification Parent A/Guardian 1 has completed?

Home Care Arrangements

Court Orders or Parenting Orders (if applicable)

Are there any current court orders or parenting orders relating to the student?*

Are there any current court orders or parenting orders relating to the student?

Is there any other information you wish the school to be aware of?

CSEF Form

Please complete this section only if you are a current holder of a healthcare card. Using the link provided, download and print the form, complete an upload in the space provided below. You must provide a photocopy of both sides of the healthcare card and upload.

CSEF Application Form 2023

CSEF File Upload

Photocopy of healthcare card File Upload

Parent/Carer/Guardian Signature* - required

Please type your signature

Please sign here

Parent/Carer/Guardian Signature

Please type your signature

Please sign here

Note: The Victorian Government provides the following guidance regarding admission requirements:

Consent

The signature of:

student, if they are over 15 and living independently
parent as defined in the Family Law Act 1975. (Note: In the absence of a current court order, each parent of a child who is not 18 has equal parental responsibility.)
both parents for parents who are separated, or a copy of the court order with any impact on the relationship between the family and the school
an informal carer, with a statutory declaration.
Carers:\

1) may be a relative or other carer

2) have day-to-day care of the student regularly living with them

3) may provide any other consent required e.g. excursions.

Note for informal carer:

statutory declarations apply for 12 months
the wishes of a parent prevail in the event of a dispute between a parent legally responsible for a student and an informal carer.

Note: Secondary students may complete parts of the form and co-sign.

Disclaimer: Personal information will be held, used and disclosed in accordance with the school's Privacy Collection Notice and Privacy Policy available on its website www.sakyabram.catholic.edu.au

Mandatory field(s) marked with *

Offer of Enrolment: Request for Information Form

Student Details

Emergency Contact - Other Than Parent/Guardian

Previous School/Preschool Permission

Does the student or their parent(s)/guardian(s) speak a language other than English at home? Note: Record all languages spoken.

Medical Information

In the event of an emergency an ambulance will be called if required.

Please list specific details for any known allergies that do not lead to anaphylaxis, e.g. hay fever, rye grass, animal fur.

Additional Needs

Government Requirement

Parent A/Guardian 1

Parent B/Guardian 2

Home Care Arrangements

Court Orders or Parenting Orders (if applicable)

Please complete this section only if you are a current holder of a healthcare card. Using the link provided, download and print the form, complete an upload in the space provided below. You must provide a photocopy of both sides of the healthcare card and upload.

CSEF Application Form 2023

Consent

The signature of:

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