ENROLMENT APPLICATION FORM

ENROLMENT CHECKLIST

Birth Certificate *

Please upload a copy of your child's birth certificate *

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Immunisation Record

Please upload a copy of your child's immunisation record *

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Does your child have asthma? *

YesNo

Please upload a copy of your child's asthma plan *

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Passport and Visa (for overseas students)

Please upload a copy of your child's Passport

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Please upload a copy of your child's Visa

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Baptismal Certificate (if applicable)

Please upload your child's Baptismal Certifcate

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Previous two full semester reports (not interim reports)

Please upload your child's previous semester report (1)

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Please upload your child's previous semester report (2)

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Custody/Guardianship (relevant documentation if applicable)

Please upload any relevant custody/guardianship documents

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Copies, from previous school, of most recent Benchmark levels achieved

Please upload any relevant documentation

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Copies of any learning, medical, psychological or behaviour reports that pertain the student's education
e.g. Education Adjustment Plans (EAP), diagnosis reports and assessments

Please upload any relevant documentation, reports or assessments

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A list of all previous schools attended

Please upload a list of previous schools if relevant

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Copies of Case Conferences held with Student Services

Please upload any relevant documentation

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STUDENT INFORMATION

1. Legal surname or family name *

Given name/s *

Preferred given name

2. Student's email address

3. Gender *

4. Date of Birth *

5. Place of birth *

6. In which country was the student born? *

AustraliaOther

Please specify which country the student was born in *

7. Residential Status *

Australian Citizen (please go to Nationality section)ResidentOverseas

Date of Arrival *

Copy of visa attached

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If you did not previously upload this at the beginning, please do so here.

Visa Expiry Date *

Nationality *

8. Student's Indigenous Status

Yes, Aboriginal Yes, Torres Strait IslanderNo

Is the student of Aboriginal or Torres Strait Islander origin? (for persons of both Aboriginal and Torres Strait Islander origin, please mark both 'Yes' boxes)

9. Does the student speak a language other than English at home?

No, English onlyYes, other - please specify

If more than one language, indicate the one that is spoken most often

Other than English, please specify which language is spoken most often at home. *

Has the student attended St Mary's School previously? *

YesNo

If yes- approx. dates/ year/s attended *

11. Previous School / Preschool *

12. Other family currently enrolled or enrolling at this school:

Please include students full name and current year level of other family enrolled or enrolling at this school

Name

Current year level

13. Are there any special family circumstances? *

YesNo

E.g. single parent, dual custody, foster care, access restrictions

If yes, please include any supporting legal documents as required by the school *

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14. Religion

15. Sacraments *

BaptismCommunionConfirmationNot applicable

Please select all which apply

Baptism date and Parish

Communion date and Parish

Confirmation date and Parish

STUDENT'S MEDICAL DETAILS

16. Doctor's Name *

17. Doctor's Phone Number *

18. Medical Conditions *Please advise if your child receives daily medication

19. Special Needs

20. Medical Alert Required? *

Yes No

Please supply details of alert

21. Is your child immunised? *

YesNo

Please ensure a copy of the student's immunisation record is attached at the beginning of this application

22. Consent to Medical Attention *

Yes No

In the event of illness or injury requiring urgent medical treatment I consent for medical and/or hospital attention to be sought. (If Ambulance travel is required the cost is covered by the School Ambulance Cover)

Parents/Emergency Contact will be contacted immediately in these events.

If prescription / other medication is sent to school with the student a note giving details of dosage and permission for School Staff to administer medication must accompany the student.

23. Aboriginal/Torres Strait Islander Students *

YesNo

Parental permission is given for tutorial assistance as per funding guidelines

24. Excursion Permission: consent to attend out of school activities *

YesNo

Travelling from school to various locations in the Darwin and outer Darwin area is often required for curriculum based activities.

25. Emergency Contacts

The first and second parent or guardian on page 6 will be the school's first and second priority contacts.

You must provide at least two contacts here.

Contact 1 Name *

Relationship to Student- contact 1 *

Mobile- contact 1 *

Agreement

I/we understand and accept that St Mary’s Catholic Primary School (here in known as the School) is a Christian community in which students are given the opportunity to deepen their understanding of catholic beliefs, clarify their values and develop real and practical concerns for others. The School philosophy encourages the development of personal responsibility in students, recognising and valuing individual differences, and encouraging the achievement of each one’s potential. The School provides an environment where gospel values are lived out, thus allowing students to experience the hope and optimism of the Gospel message of Jesus Christ. I/we agree to support this religious dimension of the School.
I/we accept and agree to support the standards of behaviour, discipline, and uniform which the School requires.
I/we realise that in sending my child to St Mary’s Catholic Primary School, I am undertaking certain financial commitments regarding school fees, uniforms, etc. I agree that Fees and Levies, as determined by the Principal and School Board, will be paid on receipt of Invoice. I also understand that pro-rata fees are payable for students commencing or leaving during term. If at any time and for any reason I should find myself unable to meet my financial obligations in full, I agree to contact the Finance Officer or Principal to make special interim arrangements. I understand that failure to do this will jeopardise my child’s ongoing enrolment in the School. Any expenses, costs or disbursements incurred by St Mary’s Catholic Primary School in recovering any outstanding monies, including debt collection agency fees and solicitors costs plus out of pocket expenses, shall be paid.
I/we agree that my child will take an active part in the various activities, including co-curricular, that are run as part of the School educational program, and that I will ensure their attendance at these activities.
I/we understand the importance of parental involvement with the education of my child. I agree to assist in some capacity and I understand that some commitment will be expected of me.
I/we understand and accept that the completion of this enrolment form does not guarantee enrolment.
I/we understand and accept that attendance at an enrolment interview does not guarantee an enrolment offer being made.
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 relationto this student’s individual needs, medical conditions, health care requirements and/or Parenting Orders, then the enrolment may be refused or terminated on this ground.

Parent / Guardian Signature *

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Parent / Guardian Signature

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Date *

Date

FAMILY INFORMATION

This information refers to Parents/Guardians residing at the same address as the student.

For parent/guardian not residing at the same address please complete the section 'Alternative Family Details'.

Parent / Guardian 1.

Parent / Guardian 2

26. Relationship to Student *

Relationship to Student

27. Title *E.g. Mr, Mrs, Miss, Ms, Dr.

TitleE.g. Mr, Mrs, Miss, Ms, Dr.

Parent/Guardian Given Name *

Parent Guardian Given Name

Surname or Family Name *

Surname or Family Name

Occupation *

Occupation

Parent/Guardian Nationality *

Parent/Guardian Nationality

Country of Birth *

Country of Birth

28. Does Parent/Guardian 1 speak/know a language other than English? *

No, English onlyYes, please specify

If more than one language, indicate the one that is spoken most often.

Does Parent/Guardian 2 speak/know a language other than English?

No, English onlyYes, please specify

If more than one language, indicate the one that is spoken most often.

Please specify which language *

Please specify which language

29. Employer *

Employer

30. Religion *

Religion

31. Business Phone

Business Phone

32. Mobile Phone *

Mobile Phone

33. Email *

34. Sole Parent *

YesNo

Sole Parent

YesNo

35. Australian Defence Family *

Yes, please specifyNo

Please specify

ArmyNavyAir Force

36. Family Parish

37. Family Medicare Number

38. Health Care Card *

Yes No

Expiry Date of Health Care Card

FAMILY ADDRESS DETAILS

Does the student live at this address *

PermanentlyOccasionally

If student resides at times with another family please provide details in Alternative Family section of this form.

39. Residential Address

Mailing Title *E.g. Mr and Mrs D Smith

Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

40. Postal Address

Is the Postal Address the same as the Residential Address? *

Yes No

Postal Address

Street addressStreet address line 2

City

State

Postcode

41. Is the Billing Address the same as the Residential Address? *

Yes No

Billing Address

Street address

City

State

Postcode

42. School Fee Billing

The following information is to be supplied if the Payment of School Fees is shared or from an alternative source. This information will be used in the Billing for the Fees.

Billing TitleE.g. Mr and Mrs D Smith

School Fee Billing

Street address

City

State

Postcode

Mobile Number

ALTERNATIVE FAMILY DETAILS

Are there alternative family details?

Yes No

Alternative family details refers to other Parent/Guardian not residing at the same address as the student.

This information is also required if the student resides at times with an alternative family during school terms.

Alternative Parent/Guardian 1

Alternative Parent/Guardian 2

43. Relationship to Student *

Relationship to Student

44. Title *E.g. Mr, Mrs, Miss, Ms, Dr.

TitleE.g. Mr, Mrs, Miss, Ms, Dr.

Given names *

Given names

Surname or Family Name *

Surname or Family Name

Occupation *

Occupation

Nationality *

Nationality

Country of Birth *

Country of Birth

45. Does parent/guardian speak a language other than English at home? *

No, English onlyYes, please specify

If more than one language, indicate the one that is spoken most often.

Does parent/guardian speak a language other than English at home?

No, English onlyYes, please specify

If more than one language, indicate the one that is spoken most often.

Please specify which language *

46. Employer *

Employer

47. Religion *

Religion

48. Business Phone

Business Phone

49. Mobile Phone *

Mobile Phone

50. Copy of Student Reports *

YesNo

Copy of Student Reports

YesNo

51. Email *

ALTERNATIVE FAMILY ADDRESS DETAILS

52. Residential Address

Mailing Title *E.g. Mr and Mrs D Smith

Alternative Family Residential Address *

Street address *

City *

State *

Postcode *

Mobile Number *

Is your postal address the same as your residential address? *

YesNo

Alternative Family Postal Address *

Street address *

City *

State *

Postcode *

PARENT/GUARDIAN BACKGROUND INFORMATION

The following information is required by the Australian Government and must be completed. It is used to measure the achievements of students from various backgrounds for national reporting. Individuals are not identified.

53. What is the highest year of primary or secondary school the parents/guardians have completed?

(for persons who have never attended school, mark 'Year 9 or equivalent or below')

Parent / Guardian 1 *

Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalent or below

Parent / Guardian 2

Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalent or below

54. What is the highest level of the highest qualification the parents / guardians have completed?

(mark only one box)

Parent / Guardian 1 *

Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I or IV (including trade certificate)No non-school qualification

Parent / Guardian 2

Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I or IV (including trade certificate)No non-school qualification

55. What is the occupation group of the Parent / Guardian?

The following questions refer to the parental occupation group. Please select from the appropriate parental occupation 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 the persons last occupation.
If the person has not been in paid work in the last 12 months, enter ‘8’ in the box below.

What is the occupation group of Parent / Guardian 1? *Please refer to the list of Parental Occupation Groups

What is the occupation group of the Parent / Guardian 2?Please refer to the list of Parental Occupation Groups

AUTHORISATION TO RELEASE CONFIDENTIAL INFORMATION

By completing the following information you are authorising the release of confidential information to help St Mary's support your child's leanring needs.

I *

authorise *

To release information about my child’s learning needs such as:

NAPLAN results (most recent)
Most recent school report• Speech reports
Hearing reports
Vision reports
Occupational therapy reports
Reading assessments
Paediatrician reports
Behaviour management plans
Psychological assessments
Recent PAT test results or other school based assessments
Any other information you think will help his/her schooling needs.

Student's name: *

Date of Birth *

To: St Mary's Catholic Primary School

Parent / Guardian Name *

Parent / Guardian Signature *

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Date of signature *

Contact person at previous school/daycare/ELC *

PHOTOGRPAHY / VIDEO PERMISSION FORM

Dear Parent/Guardian,

At certain times throughout the year, our students may have the opportunity to be photographed/filmed for our school publications, such as the school’s newsletter or external school websites and social media sites, or to promote the school in newspapers and other media.

The St Mary’s Catholic Primary School, Darwin/ Catholic Education Office Diocese of Darwin may also wish to use student photographs/videos in print and online promotional, marketing, media and educational materials.

We would like your permission to use your child's photograph/video for the above purposes to which you agree. Please complete the permission form below, Y for yes or N for no, next the uses you consent to.

Thank you for your continued support.

Student's Name: *

Year Level: *

NOTE: Please confirm your consent to the uses described below by ticking the relevant box. If you do not want your child's name used please select 'without name'.

I give my consent to the School using my child's photograph/video (Y or N):

On the school website: *

With or without name *

Name includedName excluded

On School Stream *

With or without name *

Name includedName excluded

On school social media sites: *

With or without name *

Name includedName excluded

In materials promoting the school, including advertising materials: *

With or without name *

Name includedName excluded

Third party media to promote the school's activities: *

With or without name *

Name includedName excluded

I give my consent to the St Mary’s Catholic Primary School, Darwin/ Catholic Education Office Diocese of Darwin to use my child's photograph/video (Y or N):

In material available free of charge to schools and education departments around Australia for the St Mary’s Catholic Primary School, Darwin/ Catholic Education Office Diocese of Darwin’s promotional, marketing, media and educational purposes without acknowledgment, remuneration or compensation. *

I understand and agree that if I wish to withdraw any consent provided above, it is my responsibility to notify the school.

Name of Parent / Guardian *

Date: *

Parent / Guardian Signature *

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Any personal information will be stored, used and disclosed in accordance with the requirements of the Privacy Act 1988 (Cth).

ACCEPTABLE USE AGREEMENT

The following agreement covers the student’s use of Internet, intranet, Student Profiles, network and email.

St Mary’s School provides all students enrolled at the school with Information Communication and Technology (ICT) facilities for educational use. Students may use these facilities for class work, research, the preparation of assignments. The resources provided include computers and peripherals, access to network resources, e-mail, and the Internet. Care must be taken to ensure the resources are protected from harm and that no users are exposed to materials considered offensive or illegal. Students and parents should carefully read the conditions below.

To have access to the school’s ICT resources, students must agree to abide by the school’s Acceptable Use Agreement.

Conditions of Use

Only software purchased or approved by the school, and installed by the school, can be used on school equipment.
Software copyright is to be observed at all times. It is illegal to copy or distribute school software. Illegal software from other sources is not to be copied to or installed on the school equipment.
Students must respect intellectual property and adhere to copyright, software piracy and fair dealing laws associated with learning technologies.
Students must follow the rules posted for the use and care of the computer equipment at all times.
Students using the ICT facilities may only do so under the supervision of school staff. Any students not following staff instructions may have further access restricted or denied.
Privacy and network security is to be observed. Students must not under any circumstances access personal files belonging to others, software or areas of the network which are not designated for their use.
The sharing of passwords is a security risk consequently students must not give their password to other students or log in with another users name under any circumstances.
All users must log off when leaving a computer.
There should be no disruption to class activities by unauthorised broadcast messages across the school network.
Virus protection is very important. If students use portable drives or discs to transfer work between the school network computers and computers outside the network, discs must be scanned for viruses prior to use on the school network. Virus checking software will be made available on the school computers for this purpose.
Printing of materials of a personal nature or unassociated with school activities are not permitted unless approval is sought from a school staff member.
The use of ICT facilities, specifically the Internet, is for educational, communication and research purposes only:

Deliberate attempts to look for or download and use material that is illegal or which would be thought of as offensive is not permitted. Only materials required for school activities as directed by teachers may be downloaded. This includes downloading of MP3’s, MPEG’s and other large files. If students should unknowingly navigate to a web site that contains material that may be considered offensive, they must clear the screen immediately and notify the teacher.

- 2 - Acceptable Use Agreement for Students

Inappropriate language or harassing others when communicating online is not permitted.

Privacy and ownership of others’ work and materials from web sites must be respected at all times.

The use of on-line chat facilities and instant messaging must only be carried out under thesupervision of a staff member and must only be as part of educational on-line activities.

Safe Internetpractises must be applied. Personal details of students may only be provided online if permission is given by a teacher.

Note: Deliberate misuse of computer equipment and software or deliberate breaches of theconditions of this agreement may result in access restrictions to ICT facilities by the student(s) involved and result in discipline by school administration.

By signing this agreement and using the equipment and resources of ST. MARY’S PRIMARY School, the student agrees to abide by these conditions for the length of his/her enrolment.

Parent

I understand the conditions under which ICT facilities are made available and agree to those conditions. I further understand that additional explanations have been provided to my child, copies of which can be obtained from the school upon request.

I understand that my child may be accessing the Internet for educational purposes or in accordance with this Agreement. I understand that any use of facilities contrary to this Agreement, or generally, will be treated as a breach of school discipline and shall be dealt with accordingly.

The school reserves the right to vary the terms of this Agreement to accommodate unforeseen circumstances relating to the use of facilities by students. Variations shall be in writing signed by the school Principal, and shall be distributed to students and shall take effect accordingly.

Please print Parent / Guardian Name: *

Address: *

Street address *

City *

State *

Postcode *

Signature *

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Date *