Enrolment Form

Please be advised that while the enrolment form itself is digital, we do still need you to come in to the school with the following:

Student Information

Student's Surname:

First:

Middle:

Date of Birth:--

Academic Year:

Calendar year of Entry:

Gender:

MaleFemale

Information

Address:

State:

Post Code:

Birthplace:

Aboriginal/Torres Strait Islander:

YesNo

Nationality:

Born outside of Australia:

Australian Permanent Resident:

YesNo

If No, Visa Class

Expiry Date:--

Date of Arrival:--

Country of Citizenship:

No. of years in Australia:

Present School:

Phone:

Address:

Parent Information

Mother / Guardian

Title:

First Name:

Surname:

Address:

Employer:

Occupation:

Phone Home:

Phone Work:

Phone Mobile:

Email:

Religion:

Parish:

Country of Citizenship:

Language spoken at home:

Father / Guardian

Title:

First Name:

Surname:

Address:

Employer:

Occupation:

Phone Home:

Phone Work:

Phone Mobile:

Email:

Religion:

Parish:

Country of Citizenship:

Language spoken at home:

Religious Denomination

Parish

Suburb

Baptism Certificate :

YesNo

Date Sacrament received:--

Name of Church:

Reconciliation :

YesNo

Date Sacrament received:--

Name of Church:

Eucharist :

YesNo

Date Sacrament received:--

Name of Church:

Confirmation Certificate :

YesNo

Date Sacrament received:--

Name of Church:

Custody/Guardianship

Name of person(s) with legal guardianship of the student :

If applicable a copy of any parenting or Restraint order is attached :

YesNo

Any other conditions enforced at law? :

Siblings currently attending Assumption Catholic Primary School?

Name:

Current Year level:

Name:

Current Year level:

Other Siblings to be Considered for Enrolment?

Name:

Year of Admission:

Year Level:

IN CASE OF EMERGENCY

Name of local friend or relative:

Relationship to Student:

Home phone no.:

Mobile phone no.:

Address:

Medical Information:

Family Doctor/Medical Clinic:

Address:

Phone No.:

Dentist/Dental Clinic:

Phone No.:

Address:

Fully immunized :

YesNo

Incomplete Immunisation :

YesNo

STUDENTS INDIVIDUAL NEEDS

The school Education Act 1999 requires the provision of: "details of any condition of the enrolee that may call for special steps to be taken for the benefit or protection of the enrolee or other persons in the school" To assist the school to respond to individual requirements please detail any special needs your child has in the following area(s) that may affect his/her learning, participation or welfare during school hours.

Medical/Health Care:

Medication:

Physical:

Orthoses/Prosthesis:

Psychological/Cognitive:

Sensory (eg. vision/hearing):

Behavioural or Safety:

Communication:

Allergies:

If medication or medical/health care services are required during school hours please provide full details, name, contact number and signed authorization by the relevant practitioner.

External Service Provision

Does your child receive any services from an external agency, which may affect educational arrangements?:

YesNo

If so, please details name of Service provider and contact number:

Does your child require special transport arrangements to and from school?

YesNo

Does your child receive Respite care on a regular basis?

YesNo

Please indicate ways in which you are able to assist our school: Eg, Talent, Time, Expertise

MEDICAL EMERGENCY AUTHORISATION

I authorise the school to seek medical/dental attention, call an ambulance or to hospitalise my son/daughter when considered necessary. I further authorise the school that if an emergency occurs requiring surgery, anaesthetic, oxygen, blood transfusion, medication and I am unable to be contacted within a reasonable time, the school has the authority to agree to medically recommended treatment by an accredited medical practitioner on my behalf.

Signature of Female Parent/Guardian

Clear

Signature of Male Parent/Guardian

Clear

DISCLOSURE

Do you agree that the information supplied on the Student Information and Family Information sections, can be provided to the relevant Parish Priest?

YesNo

AGREEMENT

I/we understand and accept that the completion of this application/enrolment form does not guarantee an enrolment interview. Successful applicants will be determined in accordance with the school's enrolment criteria.
I/we understand and accept that attendance at an interview does not guarantee an enrolment offer being made.
I/we understand that enrolment of a student in one Catholic school does not guarantee the enrolment of that student in any other Catholic school.
I/we have completed this application form fully and to the best of my/our knowledge. Further, I/we acknowledge and accept that if it can be demonstrated that I/we have withheld information relevant to the application/enrolment process, especially in relation to this stdent's individual needs, medical conditions, health care requirements and /or Parenting Orders, then the enrolment may be refused or terminated on this ground.
I/we agree to abide by the policies and directions of the school and the Catholic Education Commission of Western Australia as they are enacted from time to time.
I/we agree to pay all applicable fees charged by the school, as detailed in the Fees Schedule provided.

Signature of Female Parent/Guardian

Clear

Signature of Male Parent/Guardian

Clear

Collection of Information - Privacy Act

The School collects personal information, including sensitive information about pupils and parents or guardians before and during the course of a pupil's enrolment at Assumption Catholic Primary School. The primary purpose of collecting this information is to enable the school to provide schooling for your son/daughter.
Some of the information we collect is to satisfy the school's legal obligations, particularly to enable the school to discharge its duty of care.
Certain laws governing or relating to the operation of schools require that certain information is collected. These include Public Health and Child Protection laws.
Health information about pupils is sensitive information within the terms of the National Privacy Principles under the Privacy Act. We ask you to provide medical reports about pupils from time to time.
The school from time to time discloses personal and sensitive information to others for administrative and educational purposes. This includes to other schools, government departments, Catholic Education Office, the Catholic Education Commission, your local diocese and the parish, medical practitioners and people providing services to the school, including specialist visiting teachers, sports coaches and volunteers.
If we do not obtain the information referred to above we may not be able to enrol or continue the enrolment of your son/daughter.
Personal information collected from pupils is regularly disclosed to their parents or guardians. On occasions information such as academic and sporting achievements, pupil activities and other news is published in school newsletters, school magazines and on our website.
Parents may seek access to personal information collected about them and their son/daughter by contacting the school. Pupils may also seek access to personal information about them. However there will be occasions when access is denied. Such occasions would include where access would have an unreasonable impact on the privacy of others, where access may result in breach of the school's duty of care to the pupil or where pupils have provided information in confidence.
As you may know the school from time to time engages in fundraising activities. Information received from you may be used to make an appeal to you (It may also be disclosed to organisations that assist in the School's fundraising activities solely for the purpose). We will not disclose your personal information to third parties for their own marketing purposes without your consent.
We may include your contact details in a class list and school directory. If you do not agree to this you must advise us now.
If you provide the school with the personal information of others, such as doctors or emergency contacts, we encourage you to inform them that you are disclosing that information to the school and why, that they can access that information if they wish and that the school does not usually disclose the information to third parties.