Silverton Primary School Contact Details 2017

SILVERTON PRIMARY SCHOOL STUDENT ENROLMENT INFORMATION 2017 Computer Generated Student ID VSN STUDENT DETAILS REGISTER Number PERSONAL DETAILS OF STUDENT Surname Title Miss Ms Mr First Given Name Second Given Name Preferred Name if applicable Sex tick Male Female / / Birth Date dd-mm-yyyy Student Mobile Number PRIMARY FAMILY HOME ADDRESS No. Street or PO Box details Suburb State Postcode Telephone Number Silent Number tick Mobile Number Fax Number Yes No OFFICE USE ONLY Child s Name and Birth Date proof sighted tick Year Level Home Group Timetabling Enrolment Date House Campus Student Email Address Immunisation Certificate received tick Complete Not sighted Is there a Medical Alert for the student tick Does the student have a Disability ID Number tick Disability ID No. FAMILY DETAILS List any other family members attending this school This question is asked as a requirement of the Commonwealth Government. 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 consent to the following for my child 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 they are unable to contact me or it is otherwise impracticable to contact me to my child receiving such medical or surgical attention as may be deemed necessary by a medical practitioner or administer such first aid as the Principal or staff member may judge to be reasonably necessary Having routine inspections for head lice these will be done by qualified people appointed by the school Taking part in local excursions this is a blanket approval for the child s entire schooling at Silverton Primary Being involved in the many forms of technology that the school participates in such as interactive television radio broadcasts print and television media and the school website and having their work or image displayed in any or all of these mediums as covered under School Council approved policies If you have concerns or queries of any of the above please ask to discuss them with the schools Assistant Principal. I certify that the information contained within this form is correct. All schools across Australia are required to collect the same information* Last updated Jan-15 page 1 version 2. 06 If you are a separated family and the Student lives between houses please fill out Primary Carer Details below and Additional Family Details page 5-7. ADULT A DETAILS PRIMARY CARER Title Ms Mrs Mr Dr etc Legal Surname Legal First Name What is Adult A s occupation Who is Adult A s employer In which country was Adult A born Australia Other please specify 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 Is an interpreter required tick 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.