St Therese's Primary School (Cranbourne North) Enrolment Form

Application for Enrolment
St Therese's Catholic Primary School is a school which operates with the consent of the Bishop of Sale and is owned, operated and governed by Diocese of Sale Catholic Education Ltd (DOSCEL This form is informed by the St Therese's Catholic Primary School Enrolment Policy. Lodging this form does not guarantee enrolment at the school. Confirmation of an enrolment requires the acceptance of the Enrolment Agreement, Parent/Guardian/Carer Code of Conduct, and Student Code of Conduct if an offer of enrolment is made.

Please ensure all relevant information is attached to this Application for Enrolment when submitting. Please see the Parent/Guardian/Carer Documentation Checklist at the end of the form.
STUDENT DETAILS
Surname
Given names
Preferred name
Date of birth

DayMonthYear
Date
Entry year YYYY
Religion (include rite)
Entry year level / grade
Home Address
Gender

MaleFemaleSelf identified / Indeterminate / Intersex / Unspecified
Does the applicant have a sibling at this school?

YesNo
CONTACT 1 (PARENT 1/GUARDIAN 1/CARER 1)
Name

Title DrMrMrsMsMxGiven nameSurname
Relationship to student
Home Address
House Number
Street Name
Suburb
State
Postcode
Home Phone Number
Work Number
Mobile Number
Email
example@example.com
Occupation
What is the occupation group? (select from list of occupation groups in Appendix 1 - School Family Occupation Index)

ABCDN
Religion
Country of birth

AustraliaOther
If other, please specify which Country
Aboriginal or Torres Strait Islander origin:

Yes, AboriginalYes, Torres Strait IslanderYes, both Aboriginal & Torres Strait IslanderNeither, Aboriginal nor Torre Strait Islander
Nationality
Ethnicity if not born in Australia
Visa subclass
Visa expiry
Please provide up to date evidence of visa status from the Department of Home Affairs, including any changes to visa or citizenship as soon as notified
Does Contact 1 speak a language other than English at home? Record all languages spoken
What is the highest year of primary or secondary school Student Contact 1 (Parent 1/Guardian 1/Carer 1) has completed? (Persons who have never attended secondary school, tick Year 9 or below)
Highest year of schooling

Year 9 or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalent
Highest qualification

No post school qualificationCertificate I to IV including trade certificateAdvanced diploma/ DiplomaBachelor's degree or above
CONTACT 2 (PARENT 2 / GUARDIAN 2 / CARER 2)
Name

Title DrMrMrsMsMxGiven nameSurname
Relationship to student
Home Address
House Number
Street Name
Suburb
State
Postcode
Home Phone Number
Work Number
Mobile Number
Email
example@example.com
Occupation
(Select from list of occupation groups in Appendix 1 - School Family Occupation Index)
What is the occupation group? (select from list of occupation groups in Appendix 1 - School Family Occupation Index)

ABCDN
Religion include rite
Country of birth

AustraliaOther
If other, please specify which Country
Aboriginal or Torres Strait Islander origin:

Yes, AboriginalYes, Torres Strait IslanderYes, both Aboriginal & Torres Strait IslanderNeither, Aboriginal nor Torres Strait Islander
Nationality
Ethnicity if not born in Australia
Visa subclass
Visa expiry
Please provide up to date evidence of visa status from the Department of Home Affairs, including any changes to visa or citizenship as soon as notified.
Does Contact 2 speak a language other than English at home? Record all languages spoken
What is the level of the highest qualification Student Contact 2 (Parent 2/Guardian 2/Carer 2) has completed? (Persons who have never attended secondary school, tick Year 9 or below)
Highest year of schooling

Year 9 or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalent
Highest qualification

No post school qualificationCertificate I to IV including trade certificateAdvanced diploma/ DiplomaBachelor's degree or above
Previous School or Preschool
Name and address of current school OR Preschool:
Was the previous school attended interstate?

YesNo
I/We give permission for the school to contact the previous school or preschool and to gather relevant reports and information to support educational planning

YesNo
In the event that the student is enrolled at a new DOSCEL school, I/We give permission for the current school to provide information on this form to the new DOSCEL school to facilitate the enrolment of the student at that school

YesNo
NATIONALITY AND CITIZENSHIP
Government Requirement Nationality of student:
Ethnicity
In which country was the student born?

AustraliaOther
If other, please specify
Date of arrival in Australia OR date of return to Australia

DayMonthYear
Date
What is the residential status of the student?

PermanentTemporary
Evidence of Australian Residency:

Australian CitizenPermanent ResidentEligible for Australian PassportTemporary ResidentOther/Visitor/Overseas Student
Visa sub class
Visa expiry date

DayMonthYear
Date
Previous visa sub class
* Please attach visa/ImmiCard/letter of notification and passport photo page ** Please note that all enrolments for students with visas require approval through Diocese of Sale Catholic Education Limited (DOSCEL Refer to the Dependent Full Fee Overseas Student policy (link) for further information Please provide up to date evidence of visa status from the Department of Home Affairs, including any changes to visa or citizenship as soon as notified
Does the Student speak another language, other than English?

English OnlyOther
Is the student of Aboriginal or Torres Strait Islander origin:

Yes, AboriginalYes, Torres Strait IslanderYes, both Aboriginal & Torres Strait IslanderNeither, Aboriginal nor Torres Strait Islander
Please note that student must actively identify as Aboriginal and/or Torres Strait Islander to comply with the Australian Government census
SACRAMENTAL INFORMATION
Parish where student lives:
Baptism

DayMonthYear
Date
Parish
Reconciliation

DayMonthYear
Date
Parish
Eucharist

DayMonthYear
Date
Parish
Confirmation

DayMonthYear
Date
Parish
EMERGENCY CONTACTS - (OTHER THAN CONTACTS 1 & 2, NOT A PARENT / GUARDIAN)
Emergency Contact 1
Surname
Given Name
Relationship to student
Home telephone
Mobile
Emergency Contact 2
Surname
Given Name
Relationship to student
Home telephone
Mobile
MEDICAL INFORMATION
Doctors name
Doctors address
Telephone
Medicare number
Ref number
Expiry Date
Private Health Insurance

YesNo
Private Health Insurance/Fund
Fund Number
Ambulance Cover

YesNo
Ambulance Number
Do you own a Pension / Health Care Card:

YesNo
Pension / HCC Number
Expiry
The following information is sought to enable the School to fulfill its duty of care to the student and school community and ensure that the School is safe and without risks to health and safety, so far as is reasonably practicable. This includes making any reasonable accommodations for the student. It is important that the School has accurate and up-to-date information at all times. Parents/Guardians/Carers have a positive ongoing obligation to update the School if there are any changes to the information provided below.
Medical Conditions / Allergies / Medications
Medical Conditions - Please specify all relevant medical and/or health conditions for the student, e.g. asthma, diabetes, anaphylaxis, continence/ toileting (A Medical Management Plan signed by a relevant medical practitioner (doctor/nurse) will be required for each of the medical condition listed)
Allergies: Please list specific details for any known allergies that do not lead to anaphylaxis, e.g. hay fever, rye grass,animal fur.
Medical or learning needs: Please list any known diagnoses for the student regarding their medical or learning needs e.g. Global Developmental Delay (GDD), Autism Spectrum Disorder (ASD), Attention DeficitHyperactivity Disorder (ADHD), Anxiety.
Medication Please specify any medication taken by the student and the requirements regarding the administration of medication for both prescribed and nonprescribed medications whether for ongoing or temporary illnesses
Has the student been diagnosed as being at risk of Anaphylaxis?

YesNo
If yes, do they have an Epipen or Anapen?

YesNo
Does the student know how to use their Ana or Epi pen?

YesNo
If a student is to be given medication by School staff or has a severe allergy, written authorisation is required. Please request a Medication Authority Form from the School office. It is mandatory for parents/guardians/carers to advise the School in writing of management plans for the medical conditions or allergies identified in this form with advice from medical practitioners included in instances where a formal diagnosis has been made. Please attach copies of the relevant information and action plans.

If the student has identified medical and/or health condition/diagnoses, please consider the Medical Management Policy, First Aid Policy, and supporting documents. If the student has an identified risk of anaphylaxis, please review the Anaphylaxis and First Aid policies and their supporting documents.
Immunisation - Please Attach Immunisation Certificate

IMMUNISATION (please attach an immunisation history statement) All vaccines are recorded on the Australian Immunisation Register (AIR You are required to obtain an immunisation history statement (visit MyGov) and provide it to the school with this Application for Enrolment.
Immunisation history statement attached:

YesNo
If no please provide explanation
If the student entered Australia on a humanitarian visa, did they receive a refugee health check?

YesNo
To meet duty of care obligations and facilitate the smooth transition of your child into the school, please provide all required information. This will assist the school to implement appropriate adjustments and strategies to meet the needs of your child. If the information is not provided or is incomplete, incorrect or misleading, current or ongoing enrolment may be reviewed. Health Department regulations require all children without an Immunisation History Statement to be excluded from School for a period of 14 days in the event of an outbreak of a vaccine preventable disease, such as measles. Please see Victorian Department of Health website www.health.vic.gov.au for more details.
Additional Needs
The following information is sought to enable the School to ensure that necessary supports can be identified and provided for the student. It is important that the School has accurate and up-to-date information at all times. Parents/Guardians/Carers have a positive ongoing obligation to update the School if there are any changes to the information provided below.
Is your child eligible or currently receiving National Disability Insurance Scheme (NDIS) support?

YesNo
Indicate whether the student applying for enrolment has any known or suspected special needs, disability, impairment, disorder, injury or learning difficulty:
Type a question

Autism (ASD)Behavioural ConcernsHearing ImpairmentIntellectual Diasability / Development DelayMental Health ConcernsOral language / Communication DifficultiesADD / ADHDAcquired Brain InjuryVision ImpairmentGiftednessPhysical ImpairmentOther
If you have answered "yes" to any of the above, please provide:

a. full written details of those needs including advice from appropriate medical and allied health professionals to enable the school to plan accordingly.

b. any assessment/intervention/support that the student may be currently receiving, together with relevant supporting documentation.
Has your child ever seen a:

PaediatricianPsychologist / CounsellorPhysiotherapistAudiologistOccupational TherapistSpeech PathologistPsychiatristContinence NurseOther
Is your child receiving support from a specialist service, including medical or allied health professionals (optometrist, speech therapist, psychologist or occupational therapist etc?

YesNo
If yes please provide full details and provide any relevant documentation
Do you anticipate that any accommodations and/or learning adjustments will be required for the student, having regard to:

a. Any accommodations or adjustments made at the student's previous school, pre-school or home- school.

b.Any external or medical support the student currently requires.

c.Any other matter the School may consider relevant? For example:
Type a question

Alternative teaching and learning strategiesBrailleAccess to technologyModifications to equipment, furniture and learning spaceSigningA reader or scribePersonal Carer SupportOther
Have you attached all relevant information and reports?

YesNo
Health and Safety
The following information is sought to enable the School to fulfill its duty of care and health and safety obligations. It is important that the School has accurate and up-to-date information, so that it can provide relevant supports to your child and put in place relevant controls to ensure the School remains safe and without risks to health and safety, so far as is reasonably practicable.

Parents/Guardians/Carers have a positive ongoing obligation to update the School if there are any changes to the information provided below.
To your knowledge, is there anything in your child's history or circumstances (including medical history), which might pose a risk of any type to themselves, other students, or staff at this School?

YesNo
If yes, please provide a brief description include any documents which may describe such risk
Please provide the names and contact details of health professionals and/or support personnel at the last school or other relevant agencies that have knowledge of these issues
I/We consent to the School contacting health professionals, support personnel at the student's current/previous school, pre-school or other relevant agencies.

YesNo
Travel Information
The School requires the following information to assist with bus arrangements and for the purpose of assessing conveyance allowance eligibility for students enrolling at a school outside Melbourne's metropolitan conveyance boundary and who reside 4.8 kilometres or more from the School or nearest bus stop.
Distance from home to School kilometres
Distance from home to nearest School bus stop kilometres
Proposed usual method of travelling to School eg car school bus public bus train
Siblings
List all children in your family attending school or preschool (oldest to youngest) - include applicant: School/preschoolYear/grade
List all children in your family attending school or preschool (oldest to youngest) - include applicant: School/Preschool Year/grade
Home Care Arrangements
Please select:

Living with immediate familyGuarding / CarerOut of home careShared parentingKinship careOther
Are there any other general family details of which the school should be aware of?
COURT ORDERS OR PARENTING ORDERS (if applicable)
The following information is sought to enable the School to fulfill its duty of care and health and safety obligations, and to ensure that it understands the nature of any Court orders relating to parenting of the student. This information will be used by the School to ensure that there are appropriate supports in place for the student to facilitate their effective enrolment and ongoing education.
Are there any current court orders or parenting orders relating to the student?

YesNo
Has the student previously been the subject of any Court orders or any criminal charges (including any charges that did not result in a conviction)?
Has the student previously been the subject of any Court orders or any criminal charges (including any charges that did not result in a conviction)?

YesNo
If "yes", copies of these Court Orders e.g. Intervention Orders, Family Court / Federal Magistrates Court Orders, orders relating to prior Criminal Charges of the student, or other relevant court orders must be provided to the School.

It is important that the School has accurate and up-to-date information at all times. Parents/Guardians/Carers have a positive ongoing obligation to supply to the School any subsequent court orders when they are received by the parent/guardian/carer.
Is there any other information of a legal nature you wish the School to be made aware of?

YesNo
If "yes" please describe:
PARENT/GUARDIAN/CARER DOCUMENTATION CHECKLIST
Please ensure that the following documents are attached to the Application for Enrolment form(as applicable to your child):

Student Birth CertificateStudent Baptismal, Reconciliation, Eucharist, Confirmation CertificatesImmunisation History CertificateAsthma Management PlanAnaphylaxis ASCIA PlanMedical Management Plan signed by medical practionerOther relevant medical and/or additional needs information including assessments and documentation from appropriate medical and allied health professionalVisa information – visa grant notice/ImmiCard/letter of notification and passport photo pageRelevant Court Orders (such as Intervention Orders, Family Court/Federal Circuit Court Orders, Criminal Orders in relation to the student)Any additional information you wish the School to be made aware
Please Upload any Documentation

Cancelof
SIGNATURE
Please note that the completion, signing and lodgement of this enrolment form is a pre- requisite for consideration of the enrolment of your child at the School, however, it does not guarantee enrolment. The enrolment is formalised after the Enrolment Agreement is signed, following an offer for enrolment being made by the School.
Signed Parent 1Guardian 1Carer 1

Clear
Print Name
Date
Signed Parent 2 Guardian 2 Carer 2

Clear
Print Name
Date
Please complete the Application for Enrolment and return via email to koconnell@sttcbourne.catholic.edu.au OR return your completed form and required documentation to the office
Disclaimer: Personal information will be held, used and disclosed in accordance with the school's Privacy Collection Notice and Privacy Policy enclosed with this Enrolment Pack and available on its website https://sttcbourne.catholic.edu.au/.
Appendix 1 - Parent/Guardian/Carer Occupation Index
Occupation Group A

Senior management in large business organisation, government administration and defence, and qualified professionals are included in this group.

Senior executive/manager/department head in industry, commerce, media or other large organisation

Public service manager (section head or above) regional director, health/education/police/fire services administrator

Other administrator school principal, faculty head/dean, library, museum or gallery director, research facility director

Defence forces Commissioned Officer

Professionals - generally, have a degree or higher qualifications and experience in applying this knowledge to design, develop or operate complex systems; identify, treat and advise on problems; and teach others

Health, education, law, social welfare, engineering, science, computing professional

Business management consultant, business analyst, accountant, auditor, policy analyst, actuary, valuer

Air/sea transport aircraft/ship's captain/officer/pilot, flight officer, flying instructor, air traffic controller
Occupation Group B

Other business managers, arts/media/sportspersons and associate professors are included in this group.

Owner/manager farm, construction, import/export, wholesale, manufacturing, transport, real estate business

Specialist manager finance, engineering, production, personnel, industrial relations, sales, marketing

Financial services manager bank branch manager, finance/investment/insurance broker, credit/loans officer

Retail sales/services manager shop, petrol station, restaurant, club, hotel/motel, cinema, theatre, agency

Arts/media/sports musician, actor, dancer, painter, potter, sculptor, journalist, author, media presenter, photographer, designer, illustrator, proofreader, sportsperson, coach, trainer, sports official

Associate professionals generally, have diploma/technical qualifications and support managers and professionals

Health, education, law, social welfare, engineering, science, computing technician/associate professional

Business Administration - recruitment/employment/industrial relations/training officer, market research analyst, technical sales representative, retail buyer, officer/project manager

Defence forces

Senior Non-Commissioned Officer (Senior NCO)
Occupation Group C

All tradesmen/women, clerks and skilled office, sales and service staff are included in this group.

Tradesmen/women - generally, have completed a four-year Trade Certificate, usually by apprenticeship

Clerks - bookkeeper, bank officer/post office clerk, statistical/actuarial clerk, accounting/claims/audit clerk, payroll clerk, recording/registry/filing clerk, betting clerk, stores/inventory clerk, purchasing/order clerk, bond clerk, customs agent, customer services clerk, admissions clerk

Skilled office - sales and service staff Office

Office - secretary, personal assistant, desktop publishing operator, switchboard operator

Sales - company sales representative, auctioneer, insurance agent/assessor/loss adjuster, market researcher

Service - aged/disabled/refuge/childcare worker, nanny, meter reader, parking inspector, postal worker, courier, travel agent, tour guide, flight attendant, fitness instructor, casino dealer/supervisor
Occupation Group D

Machine operators, hospitality staff, assistants, labourers and related workers are included in this group.

Drivers, mobile plant, production/processing machinery and other machinery operators

Hospitality staff hotel service supervisor, receptionist, waiter, bar attendant, kitchen hand, porter, housekeeper

Office assistants, sales assistants, and other assistants Office typist, word processing/data entry/business machine operator, receptionist, office assistant

Sales - sales assistant, motor vehicle/caravan/parts salesperson, checkout operator, cashier, bus/train conductor, ticket seller, service station attendant, car rental desk staff, street vendor, telemarketer, shelf stacker

Assistant/aide - trade's assistant, school/teacher's aide, dental assistant, veterinary nurse, nursing assistant, museum/gallery attendant, usher, home helper, salon assistant, animal attendant

Labourers and related work

Defence Forces - ranks below senior NCO not included in other categories

Agriculture, horticulture, forestry, fishing, mining worker farm overseer, shearer, wool/hide classer, farm hand, horse trainer, nurseryman, greenkeeper, gardener, tree surgeon, forestry/logging worker, miner, seafarer/fishing hand

Other worker - labourer, factory hand, storeman, guard, cleaner, caretaker, laundry worker, trolley collector, car park attendant, crossing supervisor.
Should be Empty:

Application for Enrolment

STUDENT DETAILS

CONTACT 1 (PARENT 1/GUARDIAN 1/CARER 1)

Home Address

Home Address

Previous School or Preschool

NATIONALITY AND CITIZENSHIP

SACRAMENTAL INFORMATION

EMERGENCY CONTACTS - (OTHER THAN CONTACTS 1 & 2, NOT A PARENT / GUARDIAN)

Emergency Contact 1

Emergency Contact 2

MEDICAL INFORMATION

Medical Conditions / Allergies / Medications

Immunisation - Please Attach Immunisation Certificate

Additional Needs

Health and Safety

Travel Information

Siblings

Home Care Arrangements

COURT ORDERS OR PARENTING ORDERS (if applicable)

PARENT/GUARDIAN/CARER DOCUMENTATION CHECKLIST

SIGNATURE

Please complete the Application for Enrolment and return via email to koconnell@sttcbourne.catholic.edu.au OR return your completed form and required documentation to the office

Appendix 1 - Parent/Guardian/Carer Occupation Index