Mernda Primary School Student Enrolment Form
Student Details
Personal Details of Student
Surname
*
Student Surname
First Given Name
*
Student First Given Name
Second Given Name
Student Second Given Name
Preferred Name (If applicable)
Student Preferred Name
Title (Miss/Ms/Mr)
*
Student Title
Sex (tick)
*
Male
Female
Birth Date
*
-
Day
-
Month
Year
Student Birth Date
Please upload some form of Proof of Age for the student e.g. Birth Certificate
*
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Is this child a new prep student starting at the beginning of the next school year?
*
Yes
No
Expected Student Start Date:
*
-
Day
-
Month
Year
Date
Family Details
List any other family members attending this school:
Other Family Members at Mernda Primary School
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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. As the School Start Bonus will be sent to the "Primary Care' of Prep and Year 7 student, it is imperative that the legal surname, legal first name and legal second name are recorded
ADULT A Details (Primary Carer)
Please note that Adult A will be the primary contact for all correspondence from the school, this includes payment reminders, permission forms for incursions and excursions.
Sex (tick)
*
Male
Female
Title (Ms, Mrs, Mr, Dr etc)
*
Adult A Title
Legal Surname
*
Adult A Surname
Legal First Name
*
Adult A First Name
What is Adult A's occupation?
*
Adult A Occupation
Who is Adult A's employer?
*
Adult A Employer
In which country was Adult A born?
*
Australia
Other
Please specify country Adult A was born:
*
Adult A Birth country
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
Other
Please indicate any additional languages spoken by Adult A:
*
Adult A Additional languages
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 that Adult A has completed? (tick one)
*
Bachelor degree or above
Advanced diploma or above
Certificate I to IV (including trade certificate)
No non-school qualification
What is the occupation group of Adult A? (tick one) (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,)
*
Group A
Group B
Group C
Group D
Adult A has not been in paid work for the last 12 months
ADULT B Details
Would you like to add details for Adult B?
*
Yes
No
Sex (tick)
*
Male
Female
Title (Ms, Mrs, Mr, Dr etc)
*
Adult B Title
Legal Surname
*
Adult B Surname
Legal First Name
*
Adult B First Name
What is Adult B's occupation?
*
Adult B Occupation
Who is Adult B's employer?
*
Adult B Employer
In which country was Adult B born?
*
Australia
Other
Please specify country Adult B was born:
*
Adult B Birth country
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
Other
Please indicate any additional languages spoken by Adult B:
*
Adult B Additional languages
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 that Adult B has completed? (tick one)
*
Bachelor degree or above
Advanced diploma or above
Certificate I to IV (including trade certificate)
No non-school qualification
What is the occupation group of Adult B? (tick one) (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,)
*
Group A
Group B
Group C
Group D
Adult B has not been in paid work for the last 12 months
Click here to see Parental Occupation Group Codes
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These questions are asked as a requirement of the Commonwealth Government. All school across Australia are required to collect the same information.
Main language spoken at home:
*
Preferred language of notices:
*
Are you interested in being involved in school group participation activities? (eg. School Council, excursions) (tick)
*
Adult A
Adult B
Both
Neither
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Primary Family Contact Details
Adult A Contact Details
Can we contact Adult A at work? (tick)
*
Yes
No
Is Adult A usually home during business hours? (tick)
*
Yes
No
Work Telephone No.
-
Area Code
Phone Number
Mobile Number
*
-
Area Code
Phone Number
Email Address
*
example@example.com
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.
-
Area Code
Phone Number
Mobile Number
-
Area Code
Phone Number
Email Address
example@example.com
Primary Family Home Address
Address
*
Street Address
No. & Street or PO Box
Suburb
State
Postcode
Please upload 2 proofs of residency documents (eg., rental agreement, utility bill, driver's licence)
*
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Please upload 2 proofs of residency documents (eg., rental agreement, utility bill, driver's licence)
*
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Home Number
-
Area Code
Phone Number
Silent Number (tick)
*
Yes
No
Primary Family Contact Details
Doctor's Name
*
Name of Practice:
*
Doctor's Address
*
No. & Street or PO Box No.
Street Address Line 2
Suburb
State
Postcode
Doctor's Telephone Number
*
-
Area Code
Phone Number
Doctor's Fax Number
-
Area Code
Phone Number
Current Ambulance Subscription: (tick)
*
Yes
No
Primary Family Emergency Contacts
Please add AT LEAST ONE emergency contact
*
Please add AT LEAST ONE emergency contact
*
Rows
Name
Relationship to Student
Telephone Contact
Language Spoken
Contact 1
Contact 2
Contact 3
Contact 4
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
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Demographic Details of Student
In which country was the student born?
*
Australia
Other
Date of arrival in Australia OR Date of return to Australia
*
-
Day
-
Month
Year
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:
Visa Expiry Date
-
Month
-
Day
Year
Date
Visa Statistical Code (Required for some sub-classes):
International Student ID (Not required for exchange students):
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
Other
Does the student speak English (tick)
*
Yes
No
Is the student of Aboriginal or Torres Strait Islander origin? (tick)
*
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
Usual mode of transport to school:
*
Student's Religion
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School Details
Has you child ever been enrolled at any other school?
*
Yes
No
Date of first enrolment in an Australian School
-
Month
-
Day
Year
Date
Name of previous School:
Years of previous education:
What was the language of the student's previous education?
Does the student have a Victorian Student Number (VSN)?
*
Yes
Yes, but the VSN is unknown
No. The student has never been issued a VSN.
Students VSN:
*
Is the student repeating a year? (tick)
*
Yes
No
Years of interruption to education:
Does the student require an Integration Aide (tick):
*
Yes
No
Does this student have a completed assessment?
*
Application in Progress
Application Completed
Funding Approved
Will the student be attending this school full time? (tick)
*
Yes
No
Please enter the name of the other school this student will be attending:
*
Has this student been enrolled at the above school?
*
Yes
No
Please enter the time fraction that this student will be attending THIS school (i.e. 0.8 = 4 days/week):
*
Did the student attend preschool or kindergarten? (tick)
*
Yes
No
Name of Preschool or kindergarten?
*
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Student Access of Activity Restrictions Details
Is the student at risk?
*
Yes
No
Please provide any accompanying details of this.
Is there an Access Alert for the student? (tick)
*
Yes
No
Access Type: (tick)
*
Court Order
Family Law Order
Restraining Order
Other
Please upload a copy of the relevant Access Alert documentation.
*
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Describe any Access Restriction:
Are there any Activity Restrictions for the student? (tick)
*
Yes
No
Please describe the Activity Restriction for this student:
*
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Student Medical Details
Does the student suffer from any of the following impairments? (tick)
Hearing
Speech
Vision
Mobility
Is there a Medical Alert for your Child? (tick)
*
Yes
No
Please provide details of Medical Alert for you Child (does not apply to Anaphylaxis, Allergies or Asthma as these are completed further in the form)
Does the student suffer from Anaphylaxis?
*
Yes
No
Please enter details about the student's Anaphylaxis:
*
Please attach Anaphylaxis plan for the student (if available)
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Does the student suffer from Allergies?
*
Yes
No
Please enter details about the student's Allergies:
*
Please attach Allergy plan for the student (if available)
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Does the student have any other medical conditions?
*
Yes
No
Please enter details about the student's other medical conditions:
*
If my child displays any of the symptoms above please: (tick all that apply)
*
Inform Doctor
Administer Medication
Inform Emergency Contact
Other
Does the student take medication? (tick)
*
Yes
No
Name of medication taken:
*
Is the medication taken regularly but the student (preventative) or only in response to symptoms? (tick)
*
Preventative
Response
Indicate the usual dosage of medication taken:
*
Indicate how frequently the medication is taken:
*
Medication is usually administered by:
*
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Asthma Medical Condition Details
Does the student suffer from Asthma?
*
Yes
No
Please indicate if the student suffers from any of the follow symptoms: (tick all that apply)
*
Cough
Difficulty Breathing
Wheeze
Exhibits symptoms after exertion
Tight Chest
If my child displays any of these symptoms please (tick)
Inform Doctor
Inform Emergency Contact
Administer Medication
Other
Please upload a copy of the student's Asthma Management Plan (if available)
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Is the Asthma Chronic or Seasonal?
*
Chronic
Seasonal
Does the student take medication? (tick)
*
Yes
No
Name of medication taken:
*
Asthma Medication to be stored in? (tick)
*
Classroom
First Aid Room
Is the medication taken regularly by the student (preventative) or only in response to symptoms?
*
Preventative
Response
Indicate how frequently the medication is taken:
*
Indicate the usual dosage of medication taken:
*
Please upload a copy of the student most recent immunisation certificate
*
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Confirm that all details in this form are correct
By filling out the below field you certify that the information contained within this form is correct.
Please enter your full name:
*
Relationship to child:
*
Signature of Parent/Guardian
*
Date
-
Month
-
Day
Year
Date
How did you first hear about Mernda Primary School?
*
Word of Mouth (Family and Friends)
Social Media
School Website
Kindergarten/Child Care
Taste of School Tour
Interactive Magnet
School Community Events (Eg. School Fete)
Other
What were the main contributing factors offered by Mernda Primary School that influenced your decision to enrol your child here? (Tick all that apply)
*
Classroom Structure
Playgrounds and School Facilities
Curriculum Programs Offered
Digital Technologies Provided
Mernda PS Staff - Teachers, Admin and Leadership
My other children already attend Mernda Primary School
Word of Mouth/Reputation
School Location
School Website/Facebook Page
Incursion/Excursion and Camping Programs Offered
School Tour (Virtual and or Physical)
Other
Submit
Should be Empty: