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Galen Catholic College
Enrolment Application Form
Enrolment Application Form
Please complete all relevant information on the Enrolment Application Form.
Ensure all check boxes are marked appropriately. Please ensure you submit all relevant documentation and read & sign the Agreement.
Incomplete and or unsigned Enrolment Application may result in a delay in processing
PLEASE NOTE: A $50 enrolment application fee must accompany this form (non-refundable).
☐ Existing Family ☐ New Family (please tick)
Student Name: ________________________________
Current School: ________________________________
Checklist
Please use the checklist below to ensure that you have completed/attached all necessary information.
£ Birth Certificate £ Copy of Baptismal Certificate if applicable £ Copies of Court Orders and Parenting Plans if applicable £ Copies of all relevant action plans for Asthma, Allergies, Diabetes and Anaphylaxis and or other medical conditions £ Immunisation certificate £ Most recent school report, any external test results and NAPLAN results £ Citizenship documents if applicable £ Special needs – supporting documents if applicable This information is imperative to ensure the wellbeing of your child at Galen Catholic College and will remain confidential. The information provided to the school must be kept up to date throughout the period of enrolment, if any circumstances change please inform the school immediately. You will be informed in writing of your acceptance or non acceptance of a position of enrolment. At the time you will also be asked to sign and return your letter of offer with a $200.00 acceptance fee payment (deductible from your school fees) PLEASE NOTE: To discuss financial arrangements or a payment plan please make an appointment with our accounts section. All conversations and arrangements are confidential.
Student Details First Name Year level applying for ___ in school year 20____.
Middle Name 1st Australian School Year (eg: 2001):
Surname 1st Australian School attended:
Preferred Name Current School Year Level
Sex ☐ Male ☐ Female Religion
Country of Birth Does the student speak a language(s) other than English at home? Yes ¨ No ¨ If Yes þ Please List Below:
Date of Birth 1. 2.
Nationality Will the student require bus travel? ☐ Yes ☐ No
Parish/Sacramental Details Sacrament Year Received Parish Received
Baptism
Reconciliation
Eucharist
Confirmation
Please list below all children in the family and the schools they are attending Full Student Name School Year Birth
Order School Attending
Child 1
Child 2
Child 3
Child 4
Family Mailing Details Family Surname
Mail to
(eg Mr & Mrs Smith)
Address (Postal)
Town State Postcode
Family Phone Number Current Parish
Contact Details – Parent / Guardian (residing with child) Details Father/Carer Mother/Carer
Title
First Name
Surname
Address – Street
Town & Post Code
Residential Guardian Yes ¨ No ¨ Yes ¨ No ¨
Home Phone Number
Business Phone Number
Mobile Phone Number
Email Address (required)
Relationship to Student
Employer
Occupation
Occupational Group (Refer to insert “List of Parental Occupations)
Group A o Group B o Group C o Group D o
Group A o Group B o Group C o Group D o
Highest Year of School Education:
Year 12 or equivalent o Year 11 or equivalent o Year 10 or equivalent o Year 9 or equivalent or below o
Year 12 or equivalent o Year 11 or equivalent o Year 10 or equivalent o Year 9 or equivalent or below o
Level of Highest Qualification Bachelor degree or above o Advanced Diploma/Diploma o Certificate I to IV (incl trade cert) o No non-school qualification o
Bachelor degree or above o Advanced Diploma/Diploma o Certificate I to IV (incl trade cert) o No non-school qualification o
Do you speak a language(s) other than English at home?
Yes ¨ No ¨ If Yes þ Please list below: 1. 2.
Yes ¨ No ¨ If Yes þ Please list below: 1. 2.
Country of Birth
Nationality
Religion
Fee Payer Yes ¨ No ¨ Yes ¨ No ¨
Do you hold a current Health Care Card?
Yes ¨ No ¨ Card No: Exp:
SIGNATURE
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Contact Details – Non Residential Parent/Guardian (if applicable)
Details Non Residential Parent (if applicable)
Please only complete if there is a Parent who does not reside at the Student’s Home Address
Title
First Name
Surname
Address - Street
Town & Post Code
Home Phone Number
Business Phone Number
Fax Number
Mobile Phone Number
Email Address
Relationship to Student
Employer
Occupation
Occupational Group
(Refer to insert “List of Parental Occupations)
Group A o Group B o Group C o Group D o
Highest Year of School Education:
Year 12 or equivalent o Year 11 or equivalent o Year 10 or equivalent o Year 9 or equivalent or below o
Level of Highest Qualification
Bachelor degree or above o Advanced Diploma/Diploma o Certificate I to IV (incl trade cert) o No non-school qualification o
Do you speak a language other than English at home?
Yes ¨ No ¨ If Yes þ Please Specify: 1. 2.
Country of Birth
Nationality
Religion
Fee Payer Yes ¨ No ¨ Yes ¨ No ¨
Student’s Residency Status What is the Student’s Residency Status? (Evidence must be provided if not born in Australia)
¨ Australian Citizen ¨ New Zealand Citizen ¨ Norfolk Islander ¨ Permanent Resident ¨ Temporary Visa Holder ¨ Bridging Visa (BRVS) ¨ Tourist or Visitor Visa (RSVS) ¨ Full Fee Paying Overseas Student (OS) For Australian Born Citizens, if the Student was living overseas for two or more years, on what date did the Student return to Australia?
For Students Born Overseas, on what date did the Student arrive in Australia?
If the Student is a Permanent or Temporary Visa Holder please provide the following information:
Current Visa Sub Class: Visa Number: Visa Expiry Date:
Passport Number:
Indigenous Identifier Are you of Aboriginal and or Torres Strait Islander descent? Yes o No o (If Yes, please tick þ one below) o Aboriginal o Torres Strait Islander o Both Aboriginal & Torres Strait Islander
Medical Details
Parent/Carer Permission: I give my permission for the school to seek information from the doctor/medical centre named below regarding any allergy or medical condition experienced by the student Yes ¨ No ¨
Doctor/Medical Centre Name Phone Number
Student’s Medicare Number Current Ambulance Subscription? Yes ¨ No ¨ It is essential you tell the Principal before your child starts school if he or she has any allergies/medical alerts, particularly ANAPHYLAXIS, or medical condition (eg: Allergies to nut, penicillin, bee stings, asthma, diabetes, epilepsy management etc). You must also advise the school as soon as you are aware of any new allergies or other medical conditions. Anaphylaxis Condition Eg: Peanuts, Insect Stings
Carries EpiPen Yes ¨ No ¨ EpiPen Expiry Date:
Allergies Eg: hayfever, etc
Other Medical Conditions Eg: asthma, diabetes, epilepsy
Medication Please list any prescribed medication to be taken by student
Immunisations Has the Immunisation Certificate been submitted? Yes ¨ No ¨
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Emergency Contact
Details Please nominate a person other than a parent who may be contacted in the event of an
emergency, if parents cannot be contacted
First Name
Surname
Home Phone Number
Business Phone Number
Mobile Phone Number
Email Address
Relationship to Student
Special Circumstances Are there any circumstances about the student seeking to be enrolled that the school should know prior to the enrolment? (eg: living apart from parental supervision, subject of a court order, out of home care arranged by the state)
If there are any court orders, please attach a copy of current court orders
Yes ¨ No ¨ If yes, please provide a brief description of the circumstances.
Special Needs Indicate whether the student applying for enrolment has any known or suspected special needs (please tick þ Yes or No for each of the following) Physical Needs Yes ¨ No ¨
Medical Needs Yes ¨ No ¨
Educational Needs Yes ¨ No ¨
Behavioural Needs Yes ¨ No ¨
Allergies Yes ¨ No ¨
Any other special needs Yes ¨ No ¨
If you have answered yes to any of the above, please provide full details of those needs and any assessment/intervention/ support that he/she may be currently receiving (Supporting documentation must be provided). If this enrolment application is successful it is essential that the school be advised promptly of any changes to the needs of the student. The school will regularly assess its ability to provide adequate services for these needs. Is your child a young person with: (please tick as applicable) ¨ autism spectrum disorders ¨ acquired brain injury ¨ behaviour disorders ¨ difficulties in the basic areas of learning
¨ a hearing impairment ¨ an intellectual disability ¨ a language disorder
¨ mental health issues ¨ a physical disability ¨ special abilities ¨ a vision impairment
Other (please specify): Legislation and CEO policy recognise that learning adjustments may be required for students with additional needs. These are provided through alternative teaching strategies and special provisions including signing, braille, a reader or scribe, access to technology, modifications to equipment, furniture and learning spaces, personal carer support What was provided for your child in his/her previous school/pre-school/educational setting? (please tick as applicable) ¨ access to technology ¨ alternative teaching and learning strategies ¨ braille
¨ English language lessons ¨ modification to equipment, furniture and learning spaces ¨ personal carer support
¨ a reader or scribe ¨ special provisions for assessments ¨ signing
¨ early intervention services eg: speech therapy, occupational therapy, other therapies
Other (please specify): Is there anything that you do or modify at home that may help us at school to meet your child’s special needs? What may be required for your child in this school? (please tick as applicable) ¨ access to technology ¨ alternative teaching and learning strategies ¨ braille
¨ English language lessons ¨ modification to equipment, furniture and learning spaces ¨ personal carer support
¨ a reader or scribe ¨ special provisions for assessments ¨ signing
Other (please specify):
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Student’s History Relevant to Risk Assessment
This school has a legal responsibility under the relevant section of the Education Act 1990 to assess and manage any risk of harm to its staff and students. This application gives you the opportunity to provide information that will help facilitate the smooth transition of students into our school setting. This may include preparing a behaviour management plan, risk assessment and risk management plan or other appropriate strategies directed at meeting the particular needs of the student. The action taken in response to the information you provide will help to safely support students in our school and contribute to ensuring the safety of your child, other students and staff. To your knowledge, is there anything in the student’s history or circumstances (including medical history) which might pose a risk of any type to the student, other students or staff at this school? Yes o No o If yes please complete the information below and provide brief description of your child’s history or circumstances (including medical history) which might pose a risk of any type to him or her, other students or staff at this school. Does your child have a past history of violent behaviour, including self-harm? Yes o No o If yes please provide details (including any Apprehended Violence Orders issued against the student)
Parent / Student Agreements
1. Beliefs and Expectations Galen’s Beliefs Galen Catholic College is a Catholic-Christian school and part of a Catholic community. As such we aim to promote Catholic-Christian education within a broadly based school curriculum. Our belief is that we should offer a thorough, professionally developed curriculum which aims at encouraging students to accept responsibility for their own learning and behaviour via a range of educational experiences.. The Catholic community believes that all policies and procedures at Galen reflect the Christian values of equal justice, love and respect for staff and students. We believe communication between school and home is essential and is to be encouraged at all times. Galen’s Expectations We expect each student and family to accept and support the Catholic nature of the school including religious education classes, camps, prayers and liturgies. As members of the Galen community, students, staff and parents are expected to uphold and to foster the unique nature of their school. We expect full student participation in all programs the College presents as part of the curriculum including class and year level camps, excursions and curriculum-related programs. To the best of their ability students, staff and parents are expected to create a learning environment based on gospel values and respect for all individual members of this community.
• We have read and understand the above. • We accept and support the expectations of the College
Mother/Father/Guardian Signature: _____________________________ Student Signature: _____________________________ Date: _____ / _____ / _____
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2. Permission to Publish Student Names / Images At certain times throughout the year, our students may have the opportunity to be photographed or filmed for our school publications, such as the school’s newsletter or website and social media, or to promote the school in newspapers and other media.
The Catholic Education Office Sandhurst (CEOS), Sandhurst and the Catholic Education Commission of Victoria Ltd (CECV) 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. (PLEASE TICK ONE OF THE BOXES BELOW)
☐ I give permission for Galen Catholic College, CEOS/CECV to use the photograph/video, name and work of my child in its/their publications and publicity*, without acknowledgment, remuneration or compensation. Examples of publications/publicity include: the Galen newsletter, Galen’s annual yearbook, Galen’s website,
Galen course guides, advertising and editorial articles in local newspapers and TV advertising.
☐ I do not give permission for Galen Catholic College, CEOS/CECV to use the photograph/video, name and work of my child in its/their publications and publicity.
Licensed under NEALS: The photograph/video may appear in material which will be available to schools and education departments around Australia under the National Educational Access Licence for Schools (NEALS), which is a licence between education departments of the various states and territories, allowing schools to use licensed material wholly and freely for educational purposes.
Name of Parent / Guardian (please circle )
Signed: Parent/Guardian Date:
If Student is aged 15+, student must also sign: Signed: Student
Date:
Any personal information will be stored, used and disclosed in accordance with the requirements of the Privacy Act 1988 (Cth).
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Agreement Please tick the following boxes and sign below
1. I/we have read and agree to the conditions outlined in the following documents (please tick all boxes as read):
¨ Enrolment Policy
¨ Schedule of Interim School Fees and Charges
¨ Parent – Student Agreements
2. I/we have included copies of the following documents with this application for enrolment (please tick appropriate
boxes):
¨ Birth Certificate
¨ Baptismal Certificate
¨ Most recent previous school reports and external test results (where applicable)
¨ Relevant Family Court Orders (where applicable)
¨ Relevant medical and/or special needs information including clinical/educational assessments (where applicable)
¨ Immunisation
¨ Citizenship documents (if applicable) 3. I/we understand that if this application is successful the information that I/we have provided must be kept up to date
throughout the period of enrolment. 4. If this enrolment is accepted I/we agree to support our child’s participation in the religious life of the school (eg school
liturgies, retreat programs). 5. If this enrolment application is successful I agree to honour the financial commitments required by the school.
(To discuss financial arrangements or a payment plan please contact the business manager for an appointment.) 6. I/we have included the Enrolment Application Fee of $ 50.00 with this application for enrolment and I/we understand
that this money will not be refundable if the application is unsuccessful. I/we have read all of the information in the Enrolment Package and understand the policies that we will need to abide by should this enrolment application be successful. I/we understand that if any misleading information has been provided, or any omission of significant, relevant information made in this application for enrolment, acceptance will not be granted, or if discovered after acceptance the enrolment may be withdrawn. SIGNED: ___________________________________ ____________________________________ (Father/Carer) (Mother/Carer) DATE: _______________________________________
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FINANCIAL COMMITMENT As the parent(s)/guardian(s) it is important you are aware that you are entering into a legal contract and therefore legally bound jointly and severally to pay all fees and charges for the enrolled child. When circumstances dictate that full payment is not possible, the obligation remains on the parent(s)/guardian(s) to discuss this with the relevant Galen representative at the time of enrolment. Subsequently to enrolment, a change in circumstances does not absolve the signatory(s) from their obligation for payment. Any change impacting the financial commitment of the signatory(s), should be communicated to the College immediately. Please note also that the College uses the services of a debt collection agency to collect fees that remain unpaid. In the event that a debt collection agency is employed to collect outstanding fees, costs of collection will be added to the outstanding debt. I agree to honour the financial commitments required by the school as per the Schedule of Fees and Charges
Parent/Guardian Signature
Parent/Guardian Signature
Print Name Print Name
Date // Date / /
Please note:
• Acceptance of this application for enrolment is subject to the approval of the Principal
• Acceptance to this school does not constitute acceptance into any other Catholic school
Galen, my place of opportunity.
Galen Catholic College
College Street, WangarattaPO Box 630 Wangaratta Vic 3676
Phone: 03 5721 6322Fax: 03 5721 6466
Web: www.galen.vic.edu.auEmail: [email protected]
