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Application For EnrolmentPlease complete all relevant information on this Application for Enrolment Form where applicable. Ensure all check boxes aremarked appropriately. Please ensure you submit all relevant documentation and read & sign the Agreement. Existing FamilyNew Family(please tick)PLEASE NOTE: A 50 enrolment application fee must accompany this form (non-refundable).Incomplete and or unsigned Enrolment Applications will result in a delay in processing.Student DetailsFirst NameYear level applying for in school year 20 .Middle Name1st Australian School Year (eg: 2001):SurnameCurrent SchoolPreferred NameCurrent School Year LevelSex Male FemaleReligionCountry of BirthDoes the student speak a language(s) other than English athome?Yes No If Yes Please List Below:Date of Birth1.2.NationalityParish/Sacramental DetailsSacramentDate ReceivedParish ReceivedCopy of Certificate ionPlease list below all children in the family and the schools they are attendingFull Student NameSchool YearBirth OrderChild1Child2Child3Child4School AttendingFamily Mailing DetailsFamily SurnameMail to(eg Mr & Mrs Smith)Address (Postal)TownStateFamily Phone NumberCurrent ParishGalen Catholic CollegeCollege StreetWangaratta, VIC 3677Ph:Fax:E:(03) 5721 6322(03) 5721 6466enrolments@galen.vic.edu.auPostcode

Contact Details – Parent / GuardianDetailsFather/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)GroupGroupGroupGroupABCD GroupGroupGroupGroup YearYearYearYearABCD Highest Year of SchoolEducation:YearYearYearYearLevel of Highest QualificationBachelor degree or above Advanced Diploma/Diploma Certificate I to IV (incl trade cert) No non-school qualification Bachelor degree or above Advanced Diploma/Diploma Certificate I to IV (incl trade cert) No non-school qualification Do you speak a language(s)other than English at home?Yes 1.Yes 1.12 or equivalent11 or equivalent10 or equivalent9 or equivalent or belowNo If Yes Please list below:2.12 or equivalent11 or equivalent10 or equivalent9 or equivalent or belowNo If Yes Please list below:2.Country of BirthNationalityReligionSIGNATUREContact Details – Non ResidentialDetailsNon Residential Parent(if applicable)Please only complete if there is a Parent whodoes not reside at the Student’s HomeAddressTitleFirst NameSurnameAddress - StreetGalen Catholic CollegeCollege StreetWangaratta, VIC 3677Ph:Fax:E:(03) 5721 6322(03) 5721 6466enrolments@galen.vic.edu.auEmergency ContactPlease nominate a person other than aparent who may be contacted in the event ofan emergency, if parents cannot be contacted

Town & Post CodeHome Phone NumberBusiness Phone NumberFax NumberMobile Phone NumberEmail AddressRelationship to StudentN/AEmployerOccupationOccupational Group(Refer to insert “List ofParental Occupations)GroupGroupGroupGroupABCD Highest Year of SchoolEducation:YearYearYearYearLevel of HighestQualificationBachelor degree or above Advanced Diploma/Diploma Certificate I to IV (incl trade cert) No non-school qualification Do you speak a languageother than English at home?Yes 1.12 or equivalent11 or equivalent10 or equivalent9 or equivalent or belowNo If Yes Please Specify:2.Country of BirthNationalityReligionStudent’s Residency StatusWhat is the Student’s Residency Status? (Evidence must be provided) 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 IdentifierAre you of Aboriginal and or Torres Strait Islander descent?Yes No (If Yes, please tick one below) Aboriginal Torres Strait Islander Both Aboriginal & Torres Strait IslanderContinued next pageGalen Catholic CollegeCollege StreetWangaratta, VIC 3677Ph:Fax:E:(03) 5721 6322(03) 5721 6466enrolments@galen.vic.edu.au

Medical DetailsParent/Carer Permission: I give my permission for the school to seek information from the doctor/medical centre namedbelow regarding 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 Principal before your child starts school if he or she has any allergies/medical alerts,particularly ANAPHYLAXIS, 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 orother 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 No Special CircumstancesAre there any circumstances about the student seeking to be enrolled that the school should know prior to the enrolment? (eg: livingapart from parental supervision, subject of a court order, out of home care arranged by the state)If there are any court orders, please attach a copy of current court ordersYes No If yes, please provide a brief description of the circumstances.Galen Catholic CollegeCollege StreetWangaratta, VIC 3677Ph:Fax:E:(03) 5721 6322(03) 5721 6466enrolments@galen.vic.edu.au

Special NeedsIndicate whether the student applying for enrolment has any known or suspected special needs (please tick Yes or No foreach of the following)Physical NeedsYes No Medical NeedsYes No Educational NeedsYes No Behavioural NeedsYes No AllergiesYes No Any other special needsYes 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 tothe needs of the student. 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 CEO policy recognise that learning adjustments may be required for students with additional needs. These areprovided through alternative teaching strategies and special provisions including signing, braille, a reader or scribe, access totechnology, 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) 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) 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):Continued next pageGalen Catholic CollegeCollege StreetWangaratta, VIC 3677Ph:Fax:E:(03) 5721 6322(03) 5721 6466enrolments@galen.vic.edu.au

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) whichmight pose a risk of any type to the student, other students or staff at this school?Yes No If 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, including self-harm?Yes If yes please provide details (including any Apprehended Violence Orders issued against the student)Continued next pageGalen Catholic CollegeCollege StreetWangaratta, VIC 3677Ph:Fax:E:(03) 5721 6322(03) 5721 6466enrolments@galen.vic.edu.auNo