WIXLIB

Galen Catholic CollegeEnrolment Application Form

Enrolment Application FormPlease complete all relevant information on the Enrolment Application Form.Ensure all check boxes are marked appropriately. Please ensure you submit all relevantdocumentation and read & sign the Agreement.Incomplete and or unsigned Enrolment Application may result in a delay in processingPLEASE NOTE: A 50 enrolment application fee must accompany this form (non-refundable). Existing Galen FamilyNew Galen Family(please tick)Student Name:Current School:ChecklistPlease use the checklist below to ensure that you have completed/attached all necessary information. Birth Certificate Copy of Baptismal Certificate if applicable Copies of Court Orders and Parenting Plans if applicable Copies of all relevant action plans for Asthma, Allergies, Diabetes and Anaphylaxis and orother medical conditions Immunisation certificate Most recent school report, any external test results and NAPLAN results Citizenship documents if applicable Special needs – supporting documents if applicableThis information is imperative to ensure the wellbeing of your child at Galen Catholic College and will remainconfidential. The information provided to the school must be kept up to date throughout the period ofenrolment, if any circumstances change please inform the school immediately.You will be informed in writing of any offer of enrolment for your child. At the time you will also be asked to signand return your letter of offer with a 200.00 acceptance fee payment (deductible from your school fees)PLEASE NOTE: To discuss financial arrangements or a payment plan please make an appointment with ourFinance Officer, Alicia Dunstan. All conversations and arrangements are confidential.

Student DetailsFirst NameYear level applying for in school year 20 .Middle Name1st Australian School Year (eg: 2001):Surname1st Australian School attended:Preferred NameCurrent School Year Level MaleSex FemaleReligionCountry of BirthDoes the student speak a language(s) other than English athome?Yes No If Yes þ Please List Below:Date of Birth1.NationalityWill the student require bus travel?2. Yes NoParish/Sacramental DetailsSacramentYear ReceivedParish Please list below all children in the family and the schools they are attendingFull Student NameSchool YearBirthOrderChild1Child2Child3Child4School AttendingFamily Mailing DetailsFamily SurnameMail to(eg Mr & Mrs Smith)Address (Postal)TownFamily Phone NumberStatePostcodeCurrent Parish

Contact Details – Parent / Guardian (residing with child)DetailsFather/CarerMother/CarerTitleFirst NameSurnameAddress – StreetTown & Post CodeResidential GuardianYes No Yes No Home Phone NumberBusiness Phone NumberMobile Phone NumberEmail Address (required)Relationship to StudentEmployerOccupationOccupational Group(Refer to insert “List ofParental Occupations)Highest Year of SchoolEducation:Level of Highest QualificationDo you speak a language(s)other than English at home?Group AoGroup AoGroup BGroup CooGroup BGroup CooGroup DoGroup DoYear 12 or equivalentoYear 12 or equivalentoYear 11 or equivalentYear 10 or equivalentooYear 11 or equivalentYear 10 or equivalentooYear 9 or equivalent or belowoYear 9 or equivalent or belowoBachelor degree or aboveoBachelor degree or aboveoAdvanced Diploma/DiplomaoCertificate I to IV (incl trade cert) oNo non-school qualificationoAdvanced Diploma/DiplomaoCertificate I to IV (incl trade cert) oNo non-school qualificationoYes 1.Yes 1.No If Yes þ Please list below:2.No If Yes þ Please list below:2.Country of BirthNationalityReligionFee PayerDo you hold a current HealthCare Card?SIGNATUREYes Yes Card No:No No Yes Yes Exp:Card No:No No Exp:

Contact Details – Non Residential Parent/Guardian (if applicable)Non Residential Parent (if applicable)DetailsPlease only complete if there is a Parent who does not reside at the Student’s HomeAddressTitleFirst NameSurnameAddress - StreetTown & Post CodeHome Phone NumberBusiness Phone NumberFax NumberMobile Phone NumberEmail AddressRelationship to StudentEmployerOccupationGroup Ao(Refer to insert “List ofParental Occupations)Group BGroup CGroup DoooHighest Year of SchoolEducation:Year 12 or equivalentYear 11 or equivalentooYear 10 or equivalentYear 9 or equivalent or belowooBachelor degree or aboveAdvanced Diploma/DiplomaooOccupational GroupLevel of HighestQualificationCertificate I to IV (incl trade cert) oNo non-school qualificationoDo you speak a languageother than English at home?Yes 1.No If Yes þ Please Specify:2.Country of BirthNationalityReligionFee PayerDo you hold a current HealthCare Card?SIGNATUREYes Yes Card No:No No Yes Yes Exp:Card No:No No Exp:

Student’s Residency StatusWhat is the Student’s Residency Status? (Evidence must be provided if not born in Australia) Australian Citizen New Zealand Citizen Norfolk Islander Permanent Resident Temporary Visa Holder Bridging Visa (BRVS) Tourist or Visitor Visa (RSVS) Full Fee Paying Overseas Student (OS)For Australian Born Citizens, if the Student was living overseas for two or moreyears, on what date did the Student return to Australia?For Students Born Overseas, on what date did the Student arrive in Australia?If the Student is a Permanent or Temporary Visa Holder please provide the following information:Current Visa Sub Class:Visa Number:Visa Expiry Date:Passport Number:Indigenous IdentifierIs your child of Aboriginal and or Torres Strait Islander descent?Yes o No o (If Yes, please tick þ one below)o Aboriginal o Torres Strait Islander o Both Aboriginal & Torres Strait IslanderMedical DetailsParent/Carer Permission: I give my permission for the school to seek information from the doctor/medical centre named belowregarding any allergy or medical condition experienced by the studentYes No Doctor/Medical Centre NamePhone NumberStudent’s Medicare NumberCurrent Ambulance Subscription?Yes No It is essential you tell the school before your child starts school if he or she has any allergies/medical alerts, particularlyANAPHYLAXIS, or medical condition (eg: Allergies to nut, penicillin, bee stings, asthma, diabetes, epilepsy management etc).You must also advise the school as soon as you are aware of any new allergies or other medical conditions.Anaphylaxis ConditionEg: Peanuts, Insect StingsCarries EpiPenYes No EpiPen Expiry Date:AllergiesEg: hayfever, etcOther Medical ConditionsEg: asthma, diabetes,epilepsyMedicationPlease list any prescribedmedication to be taken bystudentImmunisationsHas the Immunisation Certificate been submitted? Yes Continued next pageNo

Emergency ContactDetailsPlease nominate a person other than a parent who may be contacted in the event of anemergency, if parents cannot be contactedFirst NameSurnameHome Phone NumberBusiness Phone NumberMobile Phone NumberEmail AddressRelationship to StudentCourt Orders or Parenting OrdersAre there any circumstances about the student seeking to be enrolled that the school should know prior to the enrolment? (eg:living apart from parental supervision, subject of a court order, out of home care arranged by the state, shared custodyarrangements).If there are any court orders, please attach a copy of current court orders.Yes No If yes, please provide a brief description of the circumstances.Continued next page

Special NeedsIndicate whether the student applying for enrolment has any known or suspected special needs (please tick þ Yes or No foreach of the following)Physical NeedsYes No Medical NeedsYes No Educational NeedsYes No Behavioural NeedsYes No AllergiesYes No Any other specialneedsYes No If you have answered yes to any of the above, please provide full details of those needs and any assessment/intervention/support that he/she may be currently receiving (Supporting documentation must be provided).If this enrolment application is successful it is essential that the school be advised promptly of any changes to the needs of thestudent. The school will regularly assess its ability to provide adequate services for these needs.Is your child a young person with: (please tick as applicable) autism spectrum disorders acquired brain injury behaviour disorders difficulties in the basic areas of learning a hearing impairment an intellectual disability a language disorder mental health issues a physical disability special abilities a vision impairmentOther (please specify):Legislation and Catholic Education Office policy recognise that learning adjustments may be required for students withadditional needs. These are provided through alternative teaching strategies and special provisions including signing, braille, areader or scribe, access to technology, modifications to equipment, furniture and learning spaces, personal carer supportWhat was provided for your child in his/her previous school/pre-school/educational setting?(please tick as applicable) additional access to technology alternative teaching and learning strategies braille English language lessons modification to equipment, furniture and learning spaces personal carer support a reader or scribe special provisions for assessments signing early intervention services eg: speech therapy, occupational therapy, other therapiesOther (please specify):Is there anything that you do or modify at home that may help us at school to meet your child’s special needs?What may be required for your child in this school? (please tick as applicable) additional access to technology alternative teaching and learning strategies braille English language lessons modification to equipment, furniture and learning spaces personal carer support a reader or scribe special provisions for assessments signingOther (please specify):

Student’s History Relevant to Risk AssessmentThis school has a legal responsibility under the relevant section of the Education Act 1990 to assess and manage any risk ofharm to its staff and students. This application gives you the opportunity to provide information that will help facilitate thesmooth transition of students into our school setting. This may include preparing a behaviour management plan, riskassessment and risk management plan or other appropriate strategies directed at meeting the particular needs of the student.The action taken in response to the information you provide will help to safely support students in our school and contribute toensuring the safety of your child, other students and staff.To your knowledge, is there anything in the student’s history or circumstances (including medical history) which might pose arisk of any type to the student, other students or staff at this school?Yes o No oIf yes please complete the information below and provide brief description of your child’s history or circumstances (includingmedical history) which might pose a risk of any type to him or her, other students or staff at this school.Does your child have a past history of violent behaviour, or self-harm?Yes oNo oIf yes please provide details (including any Apprehended Violence Orders issued against the student)Consent to Transfer InformationGalen Catholic College may contact your child’s previous school to obtain additional information not provided in formalreports.I/we provide and express consent for all relevant health and/or educational information held by my child’s school to beprovided to Galen Catholic College. I understand that this information will be collected and used by Galen Catholic College toinform health and safety management strategies and educational programming for my child.Parent/Carer/Guardian Name:Signature:Date:Parent/Carer/Guardian Name:Signature:Date:Please refer to each school’s information about their use and disclosure of information, and information regarding theirprivacy policy. Further clarification is available on request from the principals.Continued next page