PRE-ENROLMENT APPLICATION FORM

Parent/Carers need to complete and sign this pre-enrolment application form and submit it to the office.

The Enrolment Officer will be in contact regarding possible vacancies after the information in this form has been processed.

STUDENT DETAILS

Legal family name *

Legal first name *

Legal middle name

Preferred name

Date of birth *

Gender *

Enrolment Class *

Calendar Year *

Student phone no.

Religion *

Where did you hear about Heritage? *

Country of citizenship *

Country of birth *

NESA Number

Students First Language? (please specify) *

Specify main language spoken at home. *

Nationality? (please specify) *

Does the Student identify as ATSI? *

Student residential status *

Passport number *

Passport expiry *

Date of arrival in Australia *

Visa grant number

Visa sub-class number

Visa expiry date

Please include siblings of school age or below:

Sibling surname:

Sibling first name:

Sibling date of birth:

STUDENT EDUCATION HISTORY

Name of Daycare/Pre-School institution *

Number of days per week *

Date Started *

Date Departed *

Name of School *

Year level studied *

Date started *

Date Departed *

Has your child ever been suspended or expelled from school? *

YesNo

Please give details *

Has your child ever been subject to special disciplinary problems, inside or outside of school? *

YesNo

Please give details *

Describe any academic achievements, gifts or strengths

Describe any academic difficulties or areas of need

Describe any personal characteristics, interests, hobbies or achievements. (Please note any commitments to sport or music)

Does the student have any of the following plans in place? *

Individual Education Plan (IEP)Individual Learning Plan (LP) or (PLP)Behavioural Management Plan (BMP)None

Please describe *

Does the student receive NDIS Funding?

YesNo

Does the student require English as an Additional Language support (EALD)?

YesNo

Are there any Court Orders or Legal Documentation in place relating to the care or custody of this student? (please attach relevant paperwork) *

YesNo

As you answered yes, please give details *

Is there a case worker assigned to the student? *

YesNo

Case Worker Name *

Case Worker Phone no *

Case Worker Email *

MEDICAL & EMERGENCY DETAILS

It is important that the College is informed of any medical, physical, cognitive, sensory, or social/emotional conditions or diagnosed disabilities which may affect them whilst at school.

Does the student have, or is suspected of having, any of the following conditions? (if yes, provide details below)

ADD/ADHD *

YesNo

Please describe *

Autism / Other Spectrum Disorder *

YesNo

Please describe *

Oppositional Defiant Disorder (ODD) *

YesNo

Please describe *

Hearing/Sight or Speech Difficulties *

YesNo

Please describe *

Allergy (food) *

YesNo

Confirmed Allergen *

Severity of Condition *

Prescribed with Antihistamine *

YesNo

Prescribed with EpiPen *

YesNo

What should staff look out for (signs/symptoms)? *

Allergy (environmental/animal) *

YesNo

Confirmed Allergen *

Severity of Condition *

Prescribed with Antihistamine *

YesNo

Prescribed with EpiPen *

YesNo

What should staff look out for (signs/symptoms)? *

Allergy (medication/plastic adhesives) *

YesNo

Confirmed Allergen *

Severity of Condition *

Prescribed with Antihistamine *

YesNo

Prescribed with EpiPen *

YesNo

What should staff look out for (signs/symptoms)? *

Anaphylaxis *

YesNo

Confirmed Allergen *

Severity of Condition *

Prescribed with Antihistamine *

YesNo

Prescribed with EpiPen *

YesNo

What should staff look out for (signs/symptoms)? *

Anxiety/Mental Health *

YesNo

Please describe *

Asthma *

YesNo

Severity of Condition *

Prescribed with Salbutamol (Ventolin/Asmol) *

YesNo

What should staff look out for (signs/symptoms)? *

Diabetes *

YesNo

Requires Insulin Injections *

YesNo

Has Insulin Pump *

YesNo

Requires Glucagon *

YesNo

What should staff look out for (signs/symptoms)? *

Additional Information

Epilepsy/Seizure Disorder *

YesNo

Symptoms/Treatment or medication required *

Other (please give details below)

Medical condition / disability

Symptoms

Treatment/medication required

Does the student require administration of regular medication? (Whether taken inside or outside the school) *

YesNo

Name of Medication *

Dosage *

Do you give permission for the student to be administered paracetamol for headache or minor ailments whilst at school? (please note; parent/carer will be notified before medication is administered to Primary School students) *

YesNo

I understand that it is my responsibility to provide a Medical Action Plan from the student's Doctor if I have stated a medical condition above. *

I understand that if the student requires medication, as stated above, that it is my responsibility to supply these items, in their original packaging, to the College. *

I understand that if the medical circumstances for the student change, it is my responsibility to notify the College. *

I understand that an ambulance will be called in the event of serious illness or accident. (please note; parent/carer or emergency contact will be notified) *

PARENT/CARER INFORMATION

Please specify *

Parent / Carer 1

Parent / Carer 1 - Relationship to student *

Title *

Legal surname *

Legal first name *

Preferred name

Gender *

Residential address *

Postal address (if different from residential)

Home telephone no.

Mobile phone no. *

Work telephone no.

Email *

Religion

Ecclesia (if Christadelphian)

Country of birth *

Nationality (if other than Australian)

Does this person identify as ATSI? *

Does this person identify with non-English speaking culture? (please specify) *

First Language spoken at home: *

School education level *

Tertiary education level *

Occupation

Employment type *

Parent / Carer 2

Parent / Carer 2 - Relationship to student *

Title *

Legal surname *

Legal first name *

Preferred name

Gender *

Residential address (if different from Parent / Carer 1)

Postal address (if different from Residential)

Telephone no. (if different from above)

Mobile phone no. *

Work telephone no.

Email *

Religion

Ecclesia (if Christadelphian)

Country of birth *

Nationality (if other than Australian)

Does this person identify as ATSI? *

Does this person identify with a non-English speaking culture? (please specify) *

First language spoken at home *

School education Level *

Tertiary education level *

Occupation:

Employment type: *

EMERGENCY CONTACTS

Emergency contacts are used only when we are unable to contact you. Emergency contacts should be somebody you would trust to collect the student if they are unwell (ie relative, family friend etc). You should provide at least one emergency contact other than a parent/carer.

Emergency contact 1 name *

Relationship to student *

Home telephone no.

Mobile phone no. *

Emergency contact 2 name

Relationship to student

Home telephone no.

Mobile phone no.

I understand that in listing this person/s as an emergency contact, I authorise them to collect this student from school on my behalf. *

DECLARATION

1. I/We declare, to the best of my/our knowledge, that all the information presented above is true, accurate and correct.

2. I am aware that if the information presented above is false, misleading or incomplete, any decision made as a result of this application may be changed.

3. I consent to the College contacting previous schools to obtain relevant information pertaining to this student.

Parent/Carer 1 Name *

Parent/Carer 2 Name *

Parent/Carer 1 Signature *

Clear

Parent/Carer 2 Signature

Clear

Date Signed: *

Date Signed: *

Please note that completion of this Pre-Enrolment Application Form does not guarantee enrolment. An Enrolment Officer from Heritage College will contact you about possible vacancies and, should there be vacancies available, will make arrangements for the next steps in the enrolment process to be taken.

Please upload the documents listed below to support this Enrolment Application.

SUPPORTING DOCUMENTATION

In order for this pre-enrolment to be processed in a timely manner, please ensure you upload the following documentation to support this process.

Student Birth Certificate

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Immunisation Status (available from MyGov)

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Student's latest two school reports

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NAPLAN reports ( for students who have been in grade 3, 5, 7 or 9)

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Proof of Citizenship - only required if both parents were born outside of Australia - this can be one of the following: Australian Passport, Citizenship Certificate or valid Visa documentation

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GP Healthcare Plans for illnesses such as Allergies/Asthma/Anaphylaxis etc

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GP Healthcare Plans for illnesses such as Diabetes/Epilepsy etc

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Occupational Therapy/Paediatric/Physiotherapist/Psychologist/Speech Therapy/Testing/ reports.

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Paediatric or specialist Healthcare Plans for disorders such as ADD/ADHD/ASD/ODD etc

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NDIS Documentation

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Court Orders of Legal Documentation

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