student enrolment form  · web view2020. 10. 16. · the enrolment form requests information about...

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www.dohertyscreekcollege.vic.edu.au [email protected] 60 Elmhurst Road, Truganina, 3029 (03) 8560 6079 ENROLMENT FORM The following information is required to ensure that your child is fully enrolled at school: Checklist Enrolment Form A fully completed and signed ‘Enrolment Form’ must be returned to the school If one parent on the birth certificate is not living with the child, please request an “Alternative Family Details Form” Proof of Birth Birth Certificate or Passport and proof of guardianship A passport and relevant visa documentation (or Certificate of Australian citizenship) must be presented to complete enrolment if your child was born overseas Proof of Residency Utility account of residential address (Gas or Electricity) or Signed Lease Agreement School Entry Immunisation Statement If immunised in Australia An Australian Immunisation History Statement obtained from the Australian Immunisation Register If immunised overseas An Immunisation History Statement (if born overseas) from the Australian Immunisation Register Certificates can be obtained from: The Australian Immunisation Register (AIR) Ph: 1800 653 809 A Medicare Australia Office Your Medicare online account through myGov (my.gov.au) 1 Dohertys Creek P-9 College Last Updated August 2020

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Student Enrolment Form

www.dohertyscreekcollege.vic.edu.au

[email protected]

60 Elmhurst Road, Truganina, 3029

(03) 8560 6079

ENROLMENT FORM

The following information is required to ensure that your child is fully enrolled at school:

Checklist

Enrolment Form

· A fully completed and signed ‘Enrolment Form’ must be returned to the school

If one parent on the birth certificate is not living with the child, please request an “Alternative Family Details Form”

Proof of Birth

· Birth Certificate or

· Passport and proof of guardianship

A passport and relevant visa documentation (or Certificate of Australian citizenship) must be presented to complete enrolment if your child was born overseas

Proof of Residency

· Utility account of residential address (Gas or Electricity) or

· Signed Lease Agreement

School Entry Immunisation Statement

If immunised in Australia

· An Australian Immunisation History Statement obtained from the Australian Immunisation Register

If immunised overseas

· An Immunisation History Statement (if born overseas) from the Australian Immunisation Register

Certificates can be obtained from:

· The Australian Immunisation Register (AIR) Ph: 1800 653 809

· A Medicare Australia Office

· Your Medicare online account through myGov (my.gov.au)

· The Express Plus Medicare mobile app (download from the Appstore or google play)

Documents produced by GP’s or other immunisation providers are no longer sufficient as a form of evidence

Other Relevant Document

· Intervention or Court Orders

· Medical information & forms

PRIVACY COLLECTION STATEMENT – Enrolment

Information for parents and carers – Please read before completing.

The Enrolment Form asks you for personal and health information about your child and your family. This information is collected to enable our school to educate your child and support your child’s social and emotional wellbeing and health. Our school is also required by legislation, such as the Education and Training Reform Act 2006, to collect some of this information.

Our school relies on you to provide health information about any medical condition or disability that your child has, medication your child may take while at school, any known allergies and contact details of your child’s doctor. If you do not provide all relevant health information, this may put your child’s health at risk.

Our school requires current, relevant information about all parents and carers so that we can take account of family arrangements. Please provide our school with copies of all current parenting plans AND court orders regarding parenting arrangements. Please provide copies of court orders or plans when they change. If you wish to discuss any matters regarding family arrangements in confidence, please contact the principal.

Protecting your privacy and sharing information

The information about your child and family collected through this Enrolment Form will only be shared with school staff who need to know to enable our school to educate or support your child, or to fulfil legal obligations including duty of care, anti-discrimination law and occupational health and safety law. The information collected will not be disclosed beyond the Department of Education and Training without your consent, unless such disclosure is lawful. For more about information-sharing and privacy, see our school’s privacy policy:

https://www.education.vic.gov.au/Pages/schoolsprivacypolicy.aspx

Our school’s use of online tools (including apps and other software) to collect and manage information

Our school may use online tools, such as apps and other software, to effectively collect and manage information about your child for teaching and learning purposes, parent communication and engagement; student administration; and school management purposes. When our school uses these online tools, we take steps to ensure that your child’s information is secure. If you have any concerns about the use of these online tools, please contact us.

Emergency contacts

Emergency contacts are those people you nominate for the school to contact during an emergency. Please ensure your nominated emergency contact agrees to you providing their contact details to our school and that they have read the paragraph above. It is important that you inform them that their contact details may be disclosed beyond the Department if lawful.

Student background information

The enrolment form requests information about country of birth, aboriginality, language spoken at home and parent occupation. This information enables the Department to allocate appropriate resources to our school. The Department also uses this information to plan for future educational needs in Victoria and shares some information with the Commonwealth government to monitor, plan and allocate resources.

Immunisation status

Your child’s immunisation status assists our school to manage health risks for children. The Department may also provide this information to the Department of Health and Human Services to assess immunisation rates in Victoria, but not in a way which identifies you.

Visa statusOur school also requires this information to process your child’s enrolment.

Updating your child’s personal and health informationPlease inform our school if, and when, there are any updates to any of the personal or health information you provide on the Enrolment Form.

Accessing your child’s records

Our school provides ordinary school communications and school reports to students and parents and carers who have legal decision-making responsibility for the student. Requests for any other type of student records may be made through a Freedom of Information (FOI) application. Please contact our school and we can advise you how to do this.

Student transfers between Victorian government schoolsWhen our students transfer to another Victorian government school, our school will transfer the student’s personal and health information to that next school. This may include copies of student’s school records, including any health information. Transferring this information assist the next school to provide the best possible education and support to students.

Student Details

Personal Details of Student

Date Received: __ / __ / __

CASES

Student ID __________

Disability ID Yes No

If Yes Disability ID No: _______

Surname:

Click or tap here to enter text.Title: (Miss Ms, Mrs Mr)Click or tap here to enter text.First Given Name:Click or tap here to enter text.Second Given Name:Click or tap here to enter text.

Preferred Name (if applicable):

Click or tap here to enter text.

Sex (tick):

☐ Male

☐ Female

Birth Date: (dd-mm-yyyy)

Click or tap to enter a date.

Year Level

Click or tap to enter a date.

Expected Start Date

_____ / _____ / ______

Primary Family Home Address:No. & Street:Click or tap here to enter text.Suburb:Click or tap here to enter text.State:Click or tap here to enter text.Postcode:Click or tap here to enter text.Telephone Number:Click or tap here to enter text.

Silent Number: (tick)

☐ Yes

☐ No

Mobile Number:Click or tap here to enter text.

family Details List any other family members and their year levels attending this school:

Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

This question is asked as a requirement of the Commonwealth Government. All schools across Australia are required to collect the same information.

OFFICE CHECK BOX ONLY

Year Level

Home Group

Enrolment Date

House

PERMISSIONS

Photography & filming

Attendance

I Parent Active Participation

Local School Excursions

Head Lice

Online services consent

Acceptable Use Agreement

FEES

Charges raised on CASES21

Charges added on Compass

Proof of Birth

Birth Certificate Passport

Immunisation Documents

Visa Docs/Records

Student at Risk

Yes No

Court Order / Custody Documents Provided

Yes No Pending

Medical Alert

Yes No

Asthma / Anaphylaxis / Allergy

Yes No

Plan / Docs received?

Yes No

Primary Family Details

NOTE: The ‘PRIMARY’ Family is: “the family or parent the student mostly lives with”. Additional and Alternative family forms are available from the school if this is required. These additional forms are designed to cater for varying family circumstances.

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Dohertys Creek P-9 College Last Updated August 2020

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Dohertys Creek P-9 College Last Updated August 2020

Adult A Details (Primary Carer):

Sex (tick):

☐ Male

☐ Female

Title: (Ms, Mrs, Mr, Dr etc)

Click or tap here to enter text.Legal Surname: Click or tap here to enter text.Legal First Name: Click or tap here to enter text.

What is Adult A’s occupation?

Click or tap here to enter text.

Who is Adult A’s employer?

Click or tap here to enter text.In which country was Adult A born?

☐ Australia

☐ Other (please specify):

Click or tap here to enter text.

Does Adult A speak a language other than English at home? (If more than one language is spoken at home, indicate the one that is spoken most often.) (tick)

· No, English only

· Yes (please specify):

Please indicate any additional languages spoken by Adult A:

Click or tap here to enter text.

Is an interpreter required?(tick)

☐ Yes

☐ No

What is the highest year of primary or secondary school Adult A has completed? (tick one) (For persons who have never attended school, mark ‘Year 9 or equivalent or below’.)

☐ Year 12 or equivalent

☐ Year 11 or equivalent

☐ Year 10 or equivalent

☐ Year 9 or equivalent or below

What is the level of the highest qualification the Adult A has completed? (tick one)

☐ Bachelor degree or above

☐ Advanced diploma / Diploma

☐ Certificate I to IV (including trade certificate)

☐ No non-school qualification

What is the occupation group of Adult A? Please select the appropriate parental occupation group from the attached list.

· If the person is not currently in paid work but has had a job in the last 12 months, or has retired in the last 12 months, please use their last occupation to select from the attached occupation group list.

· If the person has not been in paid work for the last 12 months, enter ‘N’.

Click or tap here to enter text.

Adult B Details:

Sex (tick):

☐ Male

☐ Female

Title: (Ms, Mrs, Mr, Dr etc)

Click or tap here to enter text.Legal Surname: Click or tap here to enter text.Legal First Name: Click or tap here to enter text.

What is Adult B’s occupation?

Click or tap here to enter text.

Who is Adult B’s employer?

Click or tap here to enter text.In which country was Adult B born?

☐ Australia

☐ Other (please specify):

Click or tap here to enter text.

Does Adult B speak a language other than English at home? (If more than one language is spoken at home, indicate the one that is spoken most often.) (tick)

· No, English only

· Yes (please specify):

Please indicate any additional languages spoken by Adult B:

Click or tap here to enter text.

Is an interpreter required?(tick)

☐ Yes

☐ No

What is the highest year of primary or secondary school Adult B has completed? (tick one) (For persons who have never attended school, mark ‘Year 9 or equivalent or below’.)

☐ Year 12 or equivalent

☐ Year 11 or equivalent

☐ Year 10 or equivalent

☐ Year 9 or equivalent or below

What is the level of the highest qualification the Adult B has completed? (tick one)

☐ Bachelor degree or above

☐ Advanced diploma / Diploma

☐ Certificate I to IV (including trade certificate)

☐ No non-school qualification

What is the occupation group of Adult B? Please select the appropriate parental occupation group from the attached list.

· If the person is not currently in paid work but has had a job in the last 12 months, or has retired in the last 12 months, please use their last occupation to select from the attached occupation group list.

· If the person has not been in paid work for the last 12 months, enter ‘N’.

Click or tap here to enter text.

These questions are asked as a requirement of the Commonwealth Government. All schools across Australia are required to collect the same information

Main language spoken at home:Click or tap here to enter text.Preferred language of notices:Click or tap here to enter text.

Are you interested in being involved in school group participation activities? (eg. School Council, excursions) (tick)

☐ Adult A

☐ Adult B

☐ Both

☐ Neither

Primary Family Contact Details

Adult A Contact Details: Business Hours:

Can we contact Adult A at work? (tick)

☐ Yes

☐ No

Is Adult A usually home during business hours? (tick)

☐ Yes

☐ No

Work Telephone No:Click or tap here to enter text.Other Work Contact information:Click or tap here to enter text.

After Hours:

Is Adult A usually home

AFTER business hours? (tick)

☐ Yes

☐ No

Home Telephone No:Click or tap here to enter text.Other After Hours Contact Information:Click or tap here to enter text.

Mobile No:

Click or tap here to enter text.

SMS Notifications:

☐ Yes

☐ No

Adult A’s preferred method of contact: (tick one)

(If Phone is selected, Email shall be used for communication that cannot be sent via phone.)

☐ Mail

☐ Email

☐ Phone

Email address:Click or tap here to enter text.

Email Notifications:

☐ Yes

☐ No

Adult B Contact Details: Business Hours:

Can we contact Adult B at work? (tick)

☐ Yes

☐ No

Is Adult B usually home during business hours? (tick)

☐ Yes

☐ No

Work Telephone No:Click or tap here to enter text.Other Work Contact information:Click or tap here to enter text.

After Hours:

Is Adult B usually home AFTER business hours? (tick)

☐ Yes

☐ No

Home Telephone No:Click or tap here to enter text.Other After Hours Contact Information:Click or tap here to enter text.

Mobile No:

Click or tap here to enter text.

SMS Notifications:

☐ Yes

☐ No

Adult B’s preferred method of contact: (tick one)

(If Phone is selected, Email shall be used for communication that cannot be sent via phone.)

☐ Mail

☐ Email

☐ Phone

Email address:Click or tap here to enter text.

Email Notifications:

☐ Yes

☐ No

Primary Family Mailing Address:

Write “As Above” if the same as Family Home Address

No. & Street or PO BoxClick or tap here to enter text.Suburb:Click or tap here to enter text.State:Click or tap here to enter text.Postcode:Click or tap here to enter text.Send Correspondence addressed to:

☐ Adult A ☐ Adult B ☐ Both adults ☐ Neither

Primary Family Doctor Details:Doctor’s NameClick or tap here to enter text.

Individual or Group Practice: (tick)

☐ Individual

Group

No. & Street or PO Box No.:Click or tap here to enter text.Suburb:Click or tap here to enter text.State:Click or tap here to enter text.Postcode:Click or tap here to enter text.Telephone NumberClick or tap here to enter text.

Current Ambulance Subscription: (tick)

☐ Yes

☐ No

Medicare Number:Click or tap here to enter text.

Primary Family Emergency Contacts:

(Please do not list Parent contact details here)

NameRelationshipTelephone ContactLanguage Spoken

(Neighbour, Relative, Friend or Other)

(If English Write “E”)

1

Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

2

Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

3

Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

4

Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

Primary Family Billing Address:

Write “As Above” if the same as Family Home Address

No. & Street or PO BoxClick or tap here to enter text.Suburb:Click or tap here to enter text.State:Click or tap here to enter text.Postcode:Click or tap here to enter text.Billing Email

☐ Adult A

☐ Adult B

☐ Other

(Please Specify)Click or tap here to enter text.

Other Primary Family Details

Relationship of Adult A to Student: (tick one)

☐ Parent

☐ Step-Parent

☐ Adoptive Parent

☐ Foster Parent

☐ Host Family

☐ Relative

☐ Friend

☐ Self

☐ Other

Relationship of Adult B to Student: (tick one)

☐ Parent

☐ Step-Parent

☐ Adoptive Parent

☐ Foster Parent

☐ Host Family

☐ Relative

☐ Friend

☐ Self

☐ Other

The student lives with the Primary Family: (tick one)

☐ Always

☐ Mostly

☐ Balanced

☐ Occasionally

☐ Never

Send Correspondence addressed to: (tick one)

☐ Adult A

☐ Adult B

☐ Both Adults

☐ Neither

Demographic Details of Student

In which country was the student born?

☐ Australia

☐ Other (please specify):

Click or tap here to enter text.

Date of arrival in Australia OR Date of return to Australia: (dd-mm-yyyy)

Click or tap to enter a date.

What is the Residential Status of the student? (tick)

☐ Permanent

☐ Temporary

Basis of Australian Residency:

☐ Eligible for Australian Passport

☐ Holds Australian Passport

☐ Holds Permanent Residency Visa

Visa Sub Class:

Click or tap here to enter text.

Visa Expiry Date:

Click or tap to enter a date.

Visa Statistical Code: (Required for some sub-classes)

Click or tap here to enter text.

International Student ID :(Not required for exchange students)

Click or tap here to enter text.

Does the student speak a language other than English at home? (tick)

( If more than one language is spoken at home, indicate the one that is spoken most often)

☐ No, English only

☐ Yes (please specify):Click or tap here to enter text.

Does the student speak English? (tick)

☐ Yes

☐ No

Is the student of Aboriginal or Torres Strait Islander origin? (tick one)

☐ No

☐ Yes, Aboriginal

☐ Yes, Torres Strait Islander

☐ Yes, Both Aboriginal & Torres Strait Islander

What is the student’s living arrangements? (tick one):

☐ At home with TWO Parents/ Guardians

☐ State Arranged Out of Home Care # (See Note)

☐ At home with ONE Parent/ Guardian

☐ Homeless Youth

☐ Independent

☐ Other (please specify) Click or tap here to enter text.

# State Arranged Out of Home Care - Students who have been subject to protective intervention by the Department of Human Services and live in alternative care arrangements away from their parents. These DHS-facilitated care arrangements include living with relatives or friends (kith and kin), living with non-relative families (foster families or adolescent community placements) and living in residential care units with rostered care staff.

Beginning of journey to school:

Map Type

Melway / VicRoads / Country Fire Authority / Other

Map Number

Click or tap here to enter text.

X Reference

Click or tap here to enter text.

Y Reference

Click or tap here to enter text.

Usual mode of transport to school: (tick)

☐ Walking

☐ School Bus

☐ Train

☐ Driven

☐ Taxi

☐ Bicycle

☐ Public Bus

☐ Tram

☐ Self Driven

☐ Other

If student drives themself to school:

Car Reg. No.

Click or tap here to enter text.

Distance to School in kilometres:

Click or tap here to enter text.

These questions are asked as a requirement of the Commonwealth Government. All schools across Australia are required to collect the same information.

School Details

Date of first enrolment in an Australian School:

Click or tap to enter a date.

Name of previous School:Click or tap here to enter text.

Years of previous education:

Click or tap to enter a date.

What was the language of the student’s previous education?

Click or tap here to enter text.

Does the student have a Victorian Student Number (VSN)?

☐ Yes.

Please write VSN # below:

☐ Yes, but the VSN is unknown

☐ No. The student has never been issued a VSN.

Click or tap here to enter text.

Years of interruption to education:

Click or tap to enter a date.

Is the student repeating a year? (tick)

☐ Yes

☐ No

Will the student be attending this school full time? (tick)

☐Yes

☐No

If No, what will be the time fraction that the student will be attending this school? (i.e: 0.8 = 4 days/week)

Other school Name:

Click or tap to enter a date.

Time fraction:

Click or tap to enter a date.

Enrolled:

☐ Yes

☐ No

Other school Name:

Click or tap to enter a date.

Time fraction:

Click or tap to enter a date.

Enrolled:

☐ Yes

☐ No

Conditional Enrolment Details

In some circumstances a child may be enrolled conditionally, particularly if the required enrolment documentation to determine the shared parental responsibility arrangements for a child is not provided. Please refer to the School Policy & Advisory Guide’s Admission page for more information (http://www.education.vic.gov.au/school/principals/spag/participation/Pages/admission.aspx).

Enrolment conditions

Click or tap here to enter text.

Click or tap here to enter text.

· Click or tap here to enter text.

Click or tap here to enter text.

OFFICE USE ONLY

Has the documentation been provided and retained on school records?

☐ Yes

☐ No

Have the conditions been met to complete the enrolment?

☐ Yes

☐ No

Student Access or Activity Restrictions Details

Is the student at risk?

☐ Yes

☐ No

Is there an Access Alert for the student? (tick)

☐ Yes (If Yes, then complete the following questions and present a current copy of the document to the school.)

☐ No (If No, move to the immunisation / medical condition details questions.)

Access Type: (tick)

☐ Parenting Order

☐ Parenting Plan

☐ Intervention Order

☐ Protection Order

☐ Informal Carer Stat Dec

☐ DHHS Authorisation

☐ Witness Protection Program Order

☐ Other

Describe any Access Restriction:Click or tap here to enter text.

Is there an Activity Alert for the student? (tick)

☐ Yes

☒ No

If Yes, then describe the Activity Restriction:

OFFICE USE ONLY

Current custody document placed on student file?

☐ Yes

☐ No

In the event of illness or injury to my child whilst at school, on an excursion, or travelling to or from school; I authorise the Principal or teacher-in-charge of my child, where the Principal or teacher-in-charge is unable to contact me, or it is otherwise impracticable to contact me to (cross out any unacceptable statement)

* Consent to my child receiving such medical or surgical attention as may be deemed necessary by a medical

practitioner,

* Administer such first aid as the Principal or staff member may judge to be reasonably necessary.

Signature of Parent/Guardian: Click or tap here to enter text. Date: _____ / _____ / ______

(Please type if enrolment is being completed electronically and emailed back to the school)

Student Medical Details

Medical Condition Details:

Does the student suffer from any of the following impairments? (tick)

Hearing:

☐ Yes

☐ No

Vision

☐ Yes

☐ No

Speech:

☐ Yes

☐ No

Mobility:

☐ Yes

☐ No

Asthma Medical Condition Details:

Does the student suffer from Asthma? (tick) If No, please go to the Other Medical Conditions section

☐ Yes

☐ No

Answer the following questions ONLY if the student suffers from any asthma medical conditions.

Please indicate if the student suffers from any of the following symptoms: (tick)

If my child displays any of these symptoms please: (tick)

☐ Cough

Inform Doctor

☐ Yes

☐ No

☐ Difficulty Breathing

Inform Emergency Contact

☐ Yes

☐ No

☐ Wheeze

Administer Medication

☐ Yes

☐ No

☐ Exhibits symptoms after exertion

Other Medical Action

☐ Yes

☐ No

☐ Tight Chest

If yes, please specify:

Click or tap here to enter text.Has an Asthma Management Plan been provided to School?

☐ Yes

☐ No

Does the student take medication? (tick)

☐ Yes

☐ No

Name of medication taken:

Click or tap here to enter text.

Is the medication taken regularly by the student (preventive) or only in response to symptoms? (tick)

☐ Preventative

☐ Response

Indicate the usual dosage of medication taken:Click or tap here to enter text.Indicate how frequently the medication is taken:Click or tap here to enter text.

Medication is usually administered by: (tick)

☐ Student

☐ First Aid

☐ Teacher

☐ Other

Medication is stored: (tick)

☐ with Student

☐ First Aid

☐ Fridge in staff room

☐ Elsewhere

Dosage time

Click or tap to enter a date.

Reminder required? (tick)

☐ Yes

☐ No

Poison Rating

Click or tap here to enter text.

ANAPHYLAXIS Medical Condition Details:

Does the student have allergies?

ANAPHYLAXIS E.g. Anaphylactic – swelling of airways, lips, mouth, tongue.

If the student suffers from Anaphylaxis you must collect an Anaphylaxis Action Plan from the College. This must be signed by your doctor and an EPIPEN provided to the school before your child’s first day at school.

☐ Yes

☐ No

If yes to either, please specify:

Click or tap here to enter text.

ALLERGY: An allergy plan must be provided to the college by prior to first day of school. This must be signed by your doctor and medication provided by parent/guardian.

☐ Yes

☐ No

If yes to either, please specify:

Click or tap here to enter text.

Other Medical Conditions

(More copies of the other medical condition forms are available on request from the school.)

Does the student have any other medical condition? (tick)

☐ Yes

☐ No

If yes, please specify:

Click or tap here to enter text.

Symptoms:

Click or tap here to enter text.

If my child displays any of the symptoms above please: (tick)

Inform Doctor

☐ Yes

☐ No

Inform Emergency Contact

☐ Yes

☐ No

Administer Medication

☐ Yes

☐ No

Other Medical Action

☐ Yes

☐ No

If yes, please specify:

Click or tap here to enter text.

Does the student take medication? (tick)

☐ Yes

☐ No

Name of medication taken:

Click or tap here to enter text.

Is the medication taken regularly by the student (preventive) or only in response to symptoms? (tick)

☐ Preventative

☐ Response

Indicate the usual dosage of medication taken:Click or tap here to enter text.

Indicate how frequently the medication is taken:

Click or tap here to enter text.

Medication is usually administered by: (tick)

☐ Student

☐ First Aid

☐ Teacher

☐ Other

Medication is stored: (tick)

☐ with Student

☐ First Aid

☐ Fridge

☐ Elsewhere

Dosage timeClick or tap here to enter text.

Reminder required? (tick)

☐ Yes

☐ No

Poison RatingClick or tap here to enter text.

Student Emergency Contacts

This section should ONLY be filled out if THIS student has emergency contacts other than the Prime Family Emergency Contacts.

NameRelationshipLanguage SpokenTelephone Contact

(Neighbour, Relative, Friend or Other)

(If English Write “E”)

1

Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

2

Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

Student Doctor Details

The following details should only be provided if this student has a Doctor and/or Medicare number different to the Primary Family.

Doctor’s Name:Click or tap here to enter text.

Individual or Group Practice: (tick)

☒ Individual

☐ Group

No. & Street or PO Box No.:Click or tap here to enter text.Suburb:Click or tap here to enter text.State:Click or tap here to enter text.Postcode:Click or tap here to enter text.Telephone NumberClick or tap here to enter text.Student Medicare Number:Click or tap here to enter text.Number on Medicare CardClick or tap here to enter text.

Thank you for taking the time to complete this Student Enrolment form. We understand that the information you have provided is confidential and will be treated as such, but the details are required to enable staff to properly enrol your child at our school.

I certify that the information contained within this form is correct.

Signature of Parent/Guardian: Click or tap here to enter text. Date: _____ / _____ / ______

(Please type if enrolment is being completed electronically and emailed back to the school)

11

Dohertys Creek P-9 College Last Updated August 2020

Parental Occupation Group Codes

The codes outlined below are to be used when providing family occupation details for enrolled students. This information is used for determining funding allocations to schools.

Group NUnemployed for more than 12 months

If you are not currently in paid work but have had a job in the last 12 months, or have retired in the last 12 months, please use your last occupation to select from the list. If you have not been in paid work for the last 12 months, enter ‘N’ into the ‘occupation code’ field on the enrolment form.

Group ASenior management in large business organisation, government administration and defence, and qualified professionals

Senior Executive / Manager / Department Head in industry, commerce, media or other large organisation

Public Service Manager (Section head or above), regional director, health / education / police / fire service administrator

Other administrator (school principal, faculty head / dean, library / museum / gallery director, research facility director)

Defence Forces Commissioned Officer

Professionals - generally have degree or higher qualifications and experience in applying this knowledge to design, develop or operate complex systems; identify, treat and advise on problems; and teach others:

Health, Education, Law, Social Welfare, Engineering, Science, Computing professional

Business (management consultant, business analyst, accountant, auditor, policy analyst, actuary, valuer)

Air/sea transport (aircraft / ship’s captain / officer / pilot, flight officer, flying instructor, air traffic controller)

Group BOther business managers, arts/media/sportspersons and associate professionals

Owner / Manager of farm, construction, import/export, wholesale, manufacturing, transport, real estate business

Specialist Manager (finance / engineering / production / personnel / industrial relations / sales / marketing)

Financial Services Manager (bank branch manager, finance / investment / insurance broker, credit / loans officer)

Retail sales / Services manager (shop, petrol station, restaurant, club, hotel/motel, cinema, theatre, agency)

Arts / Media / Sports (musician, actor, dancer, painter, potter, sculptor, journalist, author, media presenter, photographer, designer, illustrator, proof reader, sportsman/woman, coach, trainer, sports official)

Associate Professionals - generally have diploma / technical qualifications and support managers and professionals:

Health, Education, Law, Social Welfare, Engineering, Science, Computing technician / associate professional

Business / administration (recruitment / employment / industrial relations / training officer, marketing / advertising

specialist, market research analyst, technical sales representative, retail buyer, office / project manager)

Defence Forces senior Non-Commissioned Officer

Group CTradesmen/women, clerks and skilled office, sales and service staff

Tradesmen/women generally have completed a 4 year Trade Certificate, usually by apprenticeship. All tradesmen/women are included in this group

Clerks (bookkeeper, bank / PO clerk, statistical / actuarial clerk, accounting / claims / audit clerk, payroll clerk, recording / registry / filing clerk, betting clerk, stores / inventory clerk, purchasing / order clerk, freight / transport / shipping clerk, bond clerk, customs agent, customer services clerk, admissions clerk)

Skilled office, sales and service staff:

Office (secretary, personal assistant, desktop publishing operator, switchboard operator)

Sales (company sales representative, auctioneer, insurance agent/assessor/loss adjuster, market researcher)

Service (aged / disabled / refuge / child care worker, nanny, meter reader, parking inspector, postal worker,

courier, travel agent, tour guide, flight attendant, fitness instructor, casino dealer/supervisor)

Group DMachine operators, hospitality staff, assistants, labourers and related workers

Drivers, mobile plant, production / processing machinery and other machinery operators

Hospitality staff (hotel service supervisor, receptionist, waiter, bar attendant, kitchen hand, porter, housekeeper)

Office assistants, sales assistants and other assistants:

Office (typist, word processing / data entry / business machine operator, receptionist, office assistant)

Sales (sales assistant, motor vehicle / caravan / parts salesperson, checkout operator, cashier, bus / train conductor, ticket seller, service station attendant, car rental desk staff, street vendor, telemarketer, shelf stacker)

Assistant / aide (trades’ assistant, school / teacher's aide, dental assistant, veterinary nurse, nursing assistant, museum / gallery attendant, usher, home helper, salon assistant, animal attendant)

Labourers and related workers

Defence Forces - ranks below senior NCO not included above

Agriculture, horticulture, forestry, fishing, mining worker (farm overseer, shearer, wool / hide classer, farm hand, horse trainer, nurseryman, greenkeeper, gardener, tree surgeon, forestry/ logging worker, miner, seafarer / fishing hand)

Other worker (labourer, factory hand, storeman, guard, cleaner, caretaker, laundry worker, trolley collector, car park attendant, crossing supervisor

PHOTOGRAPHS AND FILMING AT OUR SCHOOL

Dohertys Creek P-9 College (the school) arranges many exciting activities for our students throughout the year.

We celebrate the efforts of our students by publicising their participation and achievement in College events in our College newsletter and in displays around the College.

In general student images and student work are used to:

·  record student participation at College and in College events

·  celebrate student effort and achievement

·  promote the College and events held by the College.

Images of students or samples of their work are integral to the College Website. The work that may be included but is not limited to includes:

·  class photos from excursions and camps

·  multimedia presentations used at assemblies or College open days

·  art work

·  sports reports

·  video recordings of performances such as assembly

We may also use photographs of our students on the College website and the College’s facebook account along with examples of their work.

Our school is seeking your consent to photograph and film your child at school to promote the school’s activities. If you consent, the school may use the photographs and film (images) for the duration of your Child’s enrolment at Dohertys Creek P-9 College:

· in the school’s learning and teaching tools (for example, classroom blogs)

· in the school’s publicly available website and social media accounts

· in promotional material for the school, including in pamphlets and public advertisements

· in the school’s newsletter and other communications to the school community and public.

Your child may be identified by first name only in these images (unless otherwise approved by yourself).

Please read this form carefully. If you do not understand any aspect, please contact the school.

Privacy Protection

Photographs and film of a person that may be capable of identifying the person may constitute a collection of ‘personal information’ under Victorian privacy law. This means that any images of your child taken by the school may constitute a collection of your child’s personal information. The school is part of the Department of Education and Training (the Department). The Department values the privacy of every person and must comply with Victorian privacy law when collecting and managing all personal information.

Ownership and Reproduction

Copyright in the images will be wholly owned by the school. This means that the school may use the images the ways described in this form without notifying, acknowledging or compensating you or your child.

Your Authority and Consent

Name of Student

Click or tap here to enter text.

Name of parent/guardian/ carer

Click or tap here to enter text.

Relationship to Student

Click or tap here to enter text.

Signature

Click or tap here to enter text.

Date

_____ / _____ / ______

I have read this form and I consent to the school photographing and filming my child (the student named below) and I acknowledge that:

· the school may use images of my child in the ways described in this form, for the duration of their enrolment at Dohertys Creek P-9 College from the date that I sign this form

· I must notify the school principal if I wish to withdraw my consent, but I may not be able to withdraw my consent if the images have already been published and are in the public

(Please type name in signature field if enrolment is being completed electronically and emailed back to the school)

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Attendance Matters

DCC

We are here!

We are on time!

We say when we’re away!

We make every day count!

PARENT ATTENDANCE AGREEMENT

“Every Day Counts”

As a parent I understand that my child’s daily attendance will support his/her in achieving his/ her personal best potential. I understand that research supports a direct link between school attendance and achievement in later life. I also acknowledge that positive peer relationships and interactions are also fostered when my child is in regular attendance at school.

I will support my child’s regular attendance by:

· Creating routines for my child so he/she is prepared for school each day (regular

bedtime, morning routine, school uniforms and bags prepared the night before).

· Ensuring my child is at school on time, every day.

· Reinforcing to my child that it is important to be at school every day.

· Speaking about school in a positive way.

· Keeping visits to friends, shopping trips, birthday celebrations and appointments to out of school hours.

· Avoiding taking my child away for holidays during the school term. In the event that it is necessary for my child to be absent for 3 weeks or more, I will notify the school in writing and will meet to discuss with the Principal. I understand that extended leave is deemed as a non-approved absence, which will be reflected in my child’s school report.

At Dohertys Creek, we understand that absences are sometimes unavoidable, for example if your child is unwell, or in times of family emergencies. It is an expectation in these instances that you inform the school.

In the event my child is absent, I will:

· Notify the school on or before the date of absence.

· I will provide a reasonable explanation of the absence.

Parent/carer Name: Click or tap here to enter text.

(Signature): Click or tap here to enter text.

(Date): _____ / _____ / ______

(Please type name in signature field if enrolment is being completed electronically and emailed back to the school)

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Dohertys Creek P-9 College Last Updated August 2020

PARENT ACTIVE PARTICIPATION AGREEMENT

“Be Informed and Involved”

Research strongly supports that children whose families actively engage in their learning and school experience, do well academically, socially and emotionally. As a parent/carer I understand that at Dohertys Creek P-9 College the home/school partnership is valued and that there is strong commitment to creating and fostering positive relationships between teachers, students and parents/carers. As a parent, I understand that there are a number of ways in which I can be both informed and actively involved in my child’s learning.

I will be informed by:

· Utilising the various forms of communication available to me by the school (eg. Compass, Facebook, School Website, Electronic Sign Board) to gain information about events.

· Using forms of communication such as emails and phone to inform teachers of my child’s absence and to make appointments to speak with my child’s teacher.

· Reading material distributed by the school such as community and school newsletters, excursion and event notices and ensure that I undertake any actions required in a timely fashion.

I will be actively involved by:

· Attending parent- teacher interviews (booked through Compass when advised by the school).

· Supporting my child’s learning by encouraging home learning and positively engaging with my child about their learning and celebrating their successes.

· Engaging in school-based forums, events, assemblies, activities and programs where relevant.

I acknowledge that as a parent I have a very important role to play to play as my child’s first and most important educator. Working together, my child’s teacher and I will promote a respectful, collaborative learning partnership that will best support my child to achieve his/ her personal best.

Parent/carer Name: Click or tap here to enter text.

(Signature): Click or tap here to enter text.

(Date): _____ / _____ / ______

(Please type name in signature field if enrolment is being completed electronically and emailed back to the school)

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Dohertys Creek P-9 College Last Updated August 2020

Local Excursions Permission

Dohertys Creek P-9 College may take students outside of school grounds to undertake educational activities in the local area.

The purpose of this form is to obtain parent/carer consent for local excursions during your child’s schooling at Dohertys Creek P-9 College.

This form does NOT provide consent for excursions that go beyond the local area.

Local excursions

Local excursions are excursions to locations within walking distance of the school and do not involve ‘Adventure Activities’.

Local excursions that your child may participate in throughout their schooling at Dohertys Creek College could include:

· Physical Education lessons at Mainview Oval – students will walk along Elmhurst Road, turning right into Mainview Road for sporting activities eg. fun run.

· Students participating in community events at the local Kindergarden (on Mainview road).

Notification of local excursions

Dohertys Creek P-9 College will NOT seek further consent from you before local excursions take place. However, we will provide advance notice to parents/carers of upcoming local excursions via Compass emails/newsfeeds.

For local excursions that occur on a recurring basis, Dohertys Creek P-9 College will notify parents/carers once only prior to the commencement of the recurring event, eg; weekly sports lessons at the local oval.

Please keep the school informed of any updated contact details to ensure you receive these notifications.

First aid and Medical Attention

Where necessary, school staff will administer first aid. School staff will also seek emergency medical attention for your child if it is considered reasonably necessary. Any costs associated with student injury rest with parents/carers unless the Department of Education and Training is liable in negligence (liability is not automatic).

Accident and ambulance cover

The Department of Education and Training does not provide student accident insurance or ambulance cover. Parents may wish to obtain this cover, depending on their health insurance arrangements and any other personal considerations.

_________________________________________________________________________________________________

Parent/carer consent for local excursions whilst enrolled at Dohertys Creek P-9 College

I have read all of the above information in relation to local excursions. I understand that:

· to ensure the school has up-to-date health and contact information about my child, I need to inform the school if this information changes

· the school will notify me prior to a local excursion(s) taking place

· I may withdraw my consent for any/all local excursions at any time prior to the day of the excursion by contacting the school in writing at [email protected] or by visiting the school Administration office.

I give permission for my child Click or tap here to enter text. (full name) to attend local excursions whilst enrolled at Dohertys Creek P-9 College.

Parent/carer Name: Click or tap here to enter text.

(Signature): Click or tap here to enter text.

(Date): _____ / _____ / ______

(Please type name in signature field if enrolment is being completed electronically and emailed back to the school)

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Dohertys Creek P-9 College Last Updated August 2020

Head lice check consent

During your child's enrolment at Dohertys Creek P-9 College there may be occasions of head lice within the classroom. In such cases, it may be necessary to inspect all students in a class. The management of head lice infestation works best when all students are involved in the inspections.

The College staff members are aware that this can be a sensitive issue and will provide necessary information to students. If head lice are found, parents will be notified and provided with advice.

I allow for my child’s hair to be inspected for headlice whilst enrolled at Dohertys Creek P-9 College by a school staff member.

I understand that this consent will remain in place for the duration of my child’s enrolment at Dohertys Creek P-9 College and agree that if I wish to withdraw this authorisation, it will be my responsibility to change my consent by completing a new consent form and retuning to the school’s General Office.

Parent/carer Name: Click or tap here to enter text.

(Signature): Click or tap here to enter text.

(Date): _____ / _____ / ______

(Please type name in signature field if enrolment is being completed electronically and emailed back to the school)

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Dohertys Creek P-9 College Last Updated August 2020

** PLEASE NOTE **

THIS CONSENT FORM NEEDS TO BE SIGNED AND RETURNED TO ENABLE YOUR CHILD TO ACCESS THE SCHOOL’S WIRELESS NETWORK

Online Services Consent Form(This consent form relates directly to the school Participation, Privacy, Record Management & Access and Copyright Policy)

At Dohertys Creek P-9 College the Internet and Digital Technologies are used throughout the curriculum as part of a blended learning approach to complement and enhance pedagogical practice and teaching and learning programs. Dohertys Creek P-9 College uses a variety of online services to develop 21st century teaching and learning skills and foster digital literacy, fluency and social responsibility in a safe environment.

We seek your consent for your child to use the Online Services outlined in

Appendix A of the school ‘Participation, Privacy, Record Management & Access and Copyright Policy’.

This consent is only required once during your child’s time at Dohertys Creek P-9 College (usually upon enrolment). At any time, a parent can request for the consent to be withdrawn but this needs to be done in discussion with the Principal.

If you do not provide consent, your child will not have access to the online services and we will be unable to provide them access to our school’s wireless network. Students without consent will be provided with alternative ‘off-line’ options to ensure that they can still participate in learning activities in the classroom.

Providing a safe online environment

Use of online services will be subject to classroom supervision during school hours. Opportunities will be provided for students to report unacceptable behaviour. If any issue arises a nominated member of staff will address this during school hours.

To further assist your child in having safe and positive experiences online, you can refer to parent information on the Australian Government’s Office of the Children’s eSafety Commissioner website: https://esafety.gov.au/

In addition, staff at our school have been advised that the use of all Online Services are strictly for teaching and learning material only (e.g. lesson plans and classwork). Staff will not upload your child’s personal, sensitive, health; or security classified information into the various Online Services.

Student responsibilities when using online services

When using Online Services, students continue to be responsible for their own behaviour as outlined in our school’s Acceptable Use Agreement (Available on our school website). The main themes of this agreement are:

· Communicate respectfully;

· Protect personal information; and

· Look after yourself and others.

Acknowledgement and Consent for student use of online services

By signing and returning this form you acknowledge, consent and confirm that:

· You have been provided with relevant information about the online services used at Dohertys Creek P-9 College. Refer to: Appendix A of the school ‘Participation, Privacy, Record Management & Access and Copyright Policy’.

· You acknowledge the policies that apply when your child uses the online services;

· You understand how your child’s personal information will be collected, used, disclosed and managed;

· You understand that this consent will continue while your child is involved in the use of the online services for the term of their enrolment at Dohertys Creek P-9 College;

· You understand that this consent on behalf of your child may be withdrawn by you at any time by written notification to the school.

Please tick one box only:

☐ I have read the information about the online services used at Dohertys Creek P-9 College and hereby consent for my child to access the online services outlined in Appendix A of the school ‘Participation, Privacy, Record Management & Access and Copyright Policy’.

OR

☐ I do not give consent for my child to access the online services outlined in Appendix A of the school ‘Participation, Privacy, Record Management & Access and Copyright Policy’. By not providing consent your child will not be able to be connected to the school wireless network and will be provided with alternative ‘off-line’ options to ensure that they can still participate in learning activities in the classroom.

Parent/Guardian Name: Click or tap here to enter text. Signature: Click or tap here to enter text. - Date: __ / __ / __

(Please type name in signature field if enrolment is being completed electronically and emailed back to the school)

Please note:

The Online Service COMPASS is a required service at Dohertys Creek P-9 College. COMPASS is our primary student management system and is required for student attendance and reporting to parents and as such parents/guardians are not able to ‘opt-out’ of its use. If you have any concerns or questions relating to the use of COMPASS please contact the school and speak to a member of the Principal Class Team (Ian Wren or Brianna Morelli).

Acceptable Use Policy

The Acceptable Use Policy relates to the use of technology by students at Dohertys Creek P-9 College and should be read in conjunction with the College’s Bullying & Harassment Policy.

Purpose of the Acceptable Use Policy

Cybersafety is an important issue for young children. By the time young children arrive at the College, many are already online or using digital technologies. They visit their favourite websites, play games and use social media or applications such as ABCkids or Club Penguin.

College Profile Statement

Dohertys Creek P-9 College recognises the need for students to be safe and responsible users of digital technologies. We believe that explicitly teaching students about safe and responsible online behaviours is essential, and is best taught in partnership with parents/carers. We request that parents/carers work with us and encourage this behaviour at home.

At Dohertys Creek P-9 College we:

· Support the rights of all members of the College community to engage in and promote a safe, inclusive and supportive learning environment.

· Have a Student Engagement and Wellbeing Policy that clearly states our College values and the expected standards of student behaviour, including actions and consequences for inappropriate behaviour.

· Educate our students to be safe and responsible users of digital technology.

· Raise our students’ awareness of issues such as online privacy, intellectual property and copyright.

· Supervise students when using digital technologies for educational purposes.

· Provide a filtered internet service, but acknowledge that full protection from inappropriate content can never be guaranteed.

· Use online sites and digital tools that support students’ learning.

· Respond to issues or incidences that have the potential to impact on the wellbeing of our students.

· Know that some online activities are illegal and as such, we may be required to report this to the police.

· Support parents/carers to understand safe and responsible use of digital technologies and the strategies that can be implemented at home.

· The following resources provide current information from both the Department of Education & Training and The Children’s eSafety Commission:

· Bullystoppers Parents/carers Interactive Learning Modules www.education.vic.gov.au/about/programs/bullystoppers/Pages/parents/carersmodules.aspx

· iParents/carers (Office of Children’s eSafety Commissioner) https://www.esafety.gov.au/education-resources/iparents/carers

Gaming Consoles and Music Devices

Students must not bring gaming consoles and/or music devices to College without permission from a teacher. Gaming consoles are to be used for educational purposes only and always under the supervision of a teacher.

Mobile Phones

Mobile phones are not permitted to be used by students at Dohertys Creek P-9 College.

Definition of Digital Technologies

This Acceptable Use Agreement applies to digital technologies, social media tools and learning environments established by our College or accessed using College owned networks or systems, including (although are not limited to):

· College owned ICT devices (e.g. desktops, tablets, laptops, printers, scanners)

· Email and instant messaging

· Internet, Intranet and Ultranet

· Social networking sites (e.g. Facebook, SuperClubsPLUS)

· Video and photo sharing websites (e.g. Picasa, Youtube)

· Blogs

· Micro-blogs (e.g. Twitter)

· Forums, discussion boards and groups (e.g. Google groups, Whirlpool)

· Wikis (e.g. Wikipedia)

· Vods and podcasts

· Video conferences and web conferences

 

This Acceptable Use Agreement applies when using any of the above digital technologies at the College, at home, during College excursions, camps and extra-curricula activities.

Safe and responsible behaviour

When using digital technologies students should communicate respectfully by:

· always thinking and checking that what they write or post is polite and respectful

· being kind to their friends and classmates and thinking about how the things they do or say online might make them feel (teachers should ask students to reflect on how they would feel)

· not sending mean or bullying messages or forwarding them to other people

· creating and presenting their own work, and if copying something from online, letting their audience know by sharing the website link to acknowledge the creator

When using digital technologies students should protect personal information by being aware that their full name, photo, birthday, address and phone number is personal information and is not to be shared online. This means students should:

· protect their friends’ information in the same way

· protect their passwords by not sharing them with anyone except their parents/ carers.

· only ever join online communities with their parents/carers’ or teacher’s guidance and permission

· never answer questions online that ask for personal information

· know not to post three or more pieces of identifiable information about themselves

When using digital technologies students should respect themselves and others by thinking about what they share online. This means students should:

· stop to think about what they post or share online

· use spaces or sites that are appropriate, and if they are not sure they ask a trusted adult for help

· protect their friends’ full names, birthdays, college names, addresses and phone numbers because this is their personal information

· speak to a trusted adult if they see something that makes them feel upset or if they need help

· speak to a trusted adult if someone is unkind to them or if they know someone else is upset or scared

· don’t deliberately search for anything rude or violent / inappropriate.

· turn off or close the screen if they see something they don’t like and tell a trusted adult

· are careful with the equipment they use.

The teacher and student will:

· discuss ways to be a safe, responsible and ethical user of digital technologies

· present ideas around the ways that students can be a smart, safe, responsible and ethical user of digital technologies

For further support with online issues students can call:

· Kids Helpline on 1800 55 1800. Parents/Carers call Parentsline 132289 or visit http://www.education.vic.gov.au/about/programs/bullystoppers/Pages/lolconsent.aspx

Evaluation

This policy will be reviewed as part of Dohertys Creek P-9 College’s three year review cycle or more often if necessary due to changes in regulations or circumstances.

Acceptable Use Agreement

Dohertys Creek P-9 College

This Acceptable Use Agreement applies when I am using any of the above digital technologies at school, at home, during school excursions, camps and extra-curricular activities.

I understand and agree to comply with the terms of acceptable use and expected standards of behaviour set out within this agreement. I understand that there are actions and consequences established within the Doherty’s P – 9 College Student Engagement and Wellbeing Policy if I do not behave appropriately.

Safe, responsible and behaviour

When I use digital technologies, I communicate respectfully by:

· always thinking and checking that what I write or post is polite and respectful

· being kind to my friends and classmates and thinking about how the things I do or say online might make them feel (ask students to reflect on how they would feel)

· not sending mean or bullying messages or forwarding them to other people.

· creating and presenting my own work, and if I copy something from online, letting my audience know by sharing the website link to acknowledge the creator

When I use digital technologies, I protect personal information by being aware that my full name, photo, birthday, address and phone number is personal information and is not to be shared online. This means I:

· protect my friends’ information in the same way

· protect my passwords and don’t share them with anyone except my parents/carers

· only ever join spaces with my parents/carers or teacher’s guidance and permission

· never answer questions online that ask for my personal information

· know not to post three or more pieces of identifiable information about myself.

When I use digital technologies, I respect myself and others by thinking about what I share online. This means I:

· stop to think about what I post or share online

· use spaces or sites that are appropriate, and if I am not sure I ask a trusted adult for help

· protect my friends’ full names, birthdays, school names, addresses and phone numbers because this is their personal information

· speak to a trusted adult if I see something that makes me feel upset or if I need help

· speak to a trusted adult if someone is unkind to me or if I know someone else is upset or scared

· don’t deliberately search for something rude or violent

· turn off or close the screen if I see something I don’t like and tell a trusted adult

· am careful with the equipment I use.

At school, we/I have:

· discussed ways to be a safe, responsible and ethical user of digital technologies.

· presented my ideas around the ways that I can be a smart, safe, responsible and ethical user of digital technologies.

I will use this knowledge at school and everywhere I use digital technologies.

Student Name:

Click or tap here to enter text.

Parents/Carer Name:

Click or tap here to enter text.

Parent/Carer Signature:

Click or tap here to enter text.

Date:

__ / __ / __

(Please type name in signature field if enrolment is being completed electronically and emailed back to the school)