Student Enrolment Form - berwicklodgeps.vic.edu.au › wp-content › ... · Web viewBerwick Lodge Primary School. 145 Mansfield Street, Berwick. PO Box 454, Berwick 3806. Telephone:

Berwick Lodge Primary School145 Mansfield Street, Berwick

PO Box 454, Berwick 3806Telephone: 9709 6700Facsimile: 9796 2198

Department of Education and TrainingPrivacy Collection Statement

The Department of Education and Training (which includes all Victorian government schools, central and regional offices) values the privacy of every person and is committed to protecting information that schools collect.

All staff, service providers (contractors) and agents, (whether paid or unpaid) of the Department, and this Victorian government school (our school), must comply with Victorian privacy law and this policy.

In Victorian government schools the management of ‘personal information’ and ‘health information’ is governed by the Privacy and Data Protection Act 2014 (Vic) and Health Records Act 2001 (Vic) (collectively, Victorian privacy law).

This policy explains how our school collects and manages personal and health information, consistent with Victorian privacy law.

DefinitionsPersonal information is information or opinion, whether true or not, about a person whose identity is apparent, or can reasonably be ascertained, from the information or opinion – that is recorded in any form. For example, a person's name, address, phone number and date of birth (age). De-identified information about students can also be personal information.

Health information is information or opinion about a person’s physical, mental or psychological health or disability, that is also personal information – whether in writing or not. This includes information or opinion about a person’s health status and medical history, immunisation status and allergies, as well as counselling records.

Sensitive information is information or opinion about a set of specific characteristics, including a person’s racial or ethnic origin, political opinions or affiliations, religious beliefs or affiliations, philosophical beliefs, sexual preferences or practices; or criminal record. It also includes health information.

What information do we collect?Our school collects the following type of information:

information about students and their family, provided by students, their family and others

How do we collect this information?Our school collects information in a number of ways, including:

in person and over the phone: from students and their family, staff, volunteers, visitors, job applicants and others

Last updated: May 2020 version 2.12

from electronic and paper documentation: including job applications, emails, invoices, enrolment forms, letters to our school, consent forms (for example: enrolment, excursion, Student Support Services consent forms), our school’s website or school-controlled social media

through online tools: such as apps and other software used by our school through any CCTV cameras located at our school.

Collection notices

When our school collects information about you, our school takes reasonable steps to advise you of certain matters. This includes the purpose of the collection, and how to access, update and correct information held about you. For information about students and their families, a collection notice is provided to parents (or mature minor students) upon enrolment.

Unsolicited information about you

Our school may receive information about you that we have taken no active steps to collect. If permitted or required by law, our school may keep records of this information. If not, we will destroy or de-identify the information when practicable, lawful and reasonable to do so.

Why do we collect this information?

Primary purposes of collecting information about students and their families

Our school collects information about students and their families when necessary to: educate students support students’ social and emotional wellbeing, and health fulfil legal requirements, including to: take reasonable steps to reduce the risk of reasonably foreseeable harm to students, staff and visitors

(duty of care) make reasonable adjustments for students with disabilities (anti discrimination law) provide a safe and secure workplace (occupational health and safety law) enable our school to:

o communicate with parents about students’ schooling matters and celebrate the efforts and achievements of students

o maintain the good order and management of our school o enable the Department to: o ensure the effective management, resourcing and administration of our school o fulfil statutory functions and duties o plan, fund, monitor, regulate and evaluate the Department’s policies, services and functions o comply with reporting requirementso investigate incidents in schools and/or respond to any legal claims against the Department,

including any of its schools.

When do we use or disclose information?Our school uses or discloses information consistent with Victorian privacy law, as follows:

for a primary purpose – as defined above for a related secondary purpose that is reasonably to be expected – for example, to enable the school

council to fulfil its objectives, functions and powers with notice and/or consent – including consent provided on enrolment and other forms when necessary to lessen or prevent a serious threat to:


o a person’s life, health, safety or welfareo the public’s health, safety or welfare

when required or authorised by law – including as a result of our duty of care, anti-discrimination law, occupational health and safety law, reporting obligations to agencies such as Department of Health and Human Services and complying with tribunal or court orders, subpoenas or Victoria Police warrants

to investigate or report unlawful activity, or when reasonably necessary for a specified law enforcement purpose, including the prevention or investigation of a criminal offence or seriously improper conduct, by or on behalf of a law enforcement agency

for Departmental research or school statistics purposes to establish or respond to a legal claim.

A unique identifier (a CASES21 code) is assigned to each student to enable the school to carry out its functions effectively.

Student transfers between Victorian government schoolsWhen a student has been accepted at, and is transferring to, another Victorian government school, our school transfers information about the student to that school. This may include copies of the student’s school records, including any health information.

This enables the next school to continue to provide for the education of the student, to support the student’s social and emotional wellbeing and health, and to fulfil legal requirements.

NAPLAN resultsNAPLAN is the national assessment for students in years 3, 5, 7 and 9, in reading, writing, language and numeracy.

When a student transfers to another Victorian government school, their NAPLAN results are able to be transferred to that next school.

Additionally, a student’s NAPLAN results are able to be provided to the student’s previous Victorian government school to enable that school to evaluate their education program.

Responding to complaintsOn occasion our school, and the Department’s central and regional offices, receive complaints from parents and others. Our school and/or the Department’s central or regional offices will use and disclose information as considered appropriate to respond to these complaints (including responding to complaints made to external organisations or agencies).

Accessing your informationAll individuals, or their authorised representative(s), have a right to access, update and correct information that our school holds about them.

Access to student informationOur school only provides school reports and ordinary school communications to parents who have a legal right to that information. Requests for access to other student information must be made by making a Freedom of Information (FOI) application through the Department’s Freedom of Information Unit (see below).


In some circumstances, an authorised representative may not be entitled to information about the student. These circumstances include when granting access would not be in the student’s best interests or would breach our duty of care to the student, would be contrary to a mature minor student’s wishes or would unreasonably impact on the privacy of another person.

Storing and securing informationOur school takes reasonable steps to protect information from misuse and loss, and from unauthorised access, modification and disclosure. Our school stores all paper and electronic records securely, consistent with the Department’s records management policy and information security standards. All school records are disposed of, or transferred to the Public Records Office Victoria, as required by the relevant Public Records Office Standard.

When using software and contracted service providers to manage information, our school assesses these according to the appropriate departmental processes. One example of this is that staff passwords for school systems are strong and updated on a regular basis, consistent with the Department’s password policy.

Updating your information We endeavour to ensure that information about students, their families and staff is accurate, complete and up to date. To update your information, please contact our school’s general office.

FOI and privacyTo make a FOI application contact:Freedom of Information UnitDepartment of Education and Training2 Treasury Place, East Melbourne VIC 3002(03) 9637 [email protected]

If you have a query or complaint about privacy, please contact:Knowledge, Privacy and Records BranchDepartment of Education and Training2 Treasury Place, East Melbourne VIC 3002(03) 8688 [email protected]

On completion of your child/ren’s enrolment form please return via email to [email protected] with:

Copy of original birth certificate or passport to provide evidence of birth date (a photocopy will be kept at the school)

Copy of Immunisation Status Certificate – this is available from the Australian Childhood Immunisation Register (https://www.humanservices.gov.au/individuals/services/medicare/australian-immunisation-register)

Written consent of both parents or provision of a court documentation.

Enrolment of your child/ren cannot be completed without this documentation.


https://www.humanservices.gov.au/individuals/services/medicare/australian-immunisation-register

https://www.humanservices.gov.au/individuals/services/medicare/australian-immunisation-register

mailto:[email protected]



Berwick Lodge Primary School145 Mansfield Street, Berwick

PO Box 454, Berwick 3806Telephone: 9709 6700

Facsimile: 9796 2198

STUDENT ENROLMENT INFORMATION – 20__ Computer Generated Student ID:

STUDENT DETAILSPERSONAL DETAILS OF STUDENT

Surname: Title: (Miss Ms, Mrs Mr)

First Given Name:

Second Given Name:

Preferred Name (if applicable):

Sex (tick): Male Female Birth Date: (dd-mm-yyyy) _______ / _______ / ________

Student Mobile Number:

PRIMARY FAMILY HOME ADDRESS:No. & Street: or PO Box details

Suburb:

State: Postcode:

Telephone Number: Silent Number: (tick) Yes No

Mobile Number: Fax Number:

OFFICE USE ONLY

Child’s Name and Birth Date proof sighted (tick) Yes No Enrolment Date:

Year Level

Home Group

Timetabling Group House Campus

Student Email Address:

Immunisation Certificate received?: (tick) Complete Not sighted

Is there a Medical Alert for the student? (tick) Yes No

Does the student have a Disability ID Number? (tick) No Yes Disability ID No.:

Has a Transition Statement been provided (either by the Early Childhood Educator or parents)? (tick)For prep students only

Yes No Pending

FAMILY DETAILS List any other family members attending this school:

This question is asked as a requirement of the Commonwealth Government. All schools across Australia are required to collect the same information.

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PRIMARY FAMILY DETAILSNOTE: 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.

ADULT A DETAILS (PRIMARY CARER):

Sex (tick): Male Female

Title: (Ms, Mrs, Mr, Dr etc)

Legal Surname:

Legal First Name:

What is Adult A’s occupation?

Who is Adult A’s employer?

In which country was Adult A born?

Australia Other (please specify):

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 Yes (please specify):

Please indicate any additional languages spoken by Adult A:

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 the Adult A has completed? (tick one)

Bachelor degree or above Advanced diploma / Diploma Certificate I to IV (including trade certificate) No non-school qualification

What is the occupation group of Adult A? 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.

If the person has not been in paid work for the last 12 months, enter ‘N’.

ADULT B DETAILS:

Sex (tick): Male Female

Title: (Ms, Mrs, Mr, Dr etc)

Legal Surname:

Legal First Name:

What is Adult B’s occupation?

Who is Adult B’s employer?

In which country was Adult B born?

Australia Other (please specify):

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 Yes (please specify):

Please indicate any additional languages spoken by Adult B:

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 the Adult B has completed? (tick one)

Bachelor degree or above Advanced diploma / Diploma Certificate I to IV (including trade certificate) No non-school qualification

What is the occupation group of Adult B? 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.

If the person has not been in paid work for the last 12 months, enter ‘N’.

These questions are asked as a requirement of the Commonwealth Government. All schools 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


PRIMARY FAMILY CONTACT DETAILSADULT A CONTACT DETAILS:Business Hours:

Can we contact Adult A at work? (tick) Yes No

Is Adult A usually home during business hours? (tick)

Yes No

Work Telephone No:

Other Work Contact information:

After Hours:Is Adult A usually home AFTER business hours? (tick)

Yes No

Home Telephone No:

Other After Hours Contact Information:

Mobile No:

SMS Notifications: Yes No

Adult A’s preferred method of contact: (tick one)(If Phone is selected, Email shall be used for communication that cannot be sent via phone.)

Mail Email Phone Facsimile

Email address:

Email Notifications: Yes No

Fax Number:

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:

Other Work Contact information:

After Hours:Is Adult B usually home AFTER business hours? (tick)

Yes No

Home Telephone No:

Other After Hours Contact Information:

Mobile No:

SMS Notifications: Yes No

Adult B’s preferred method of contact: (tick one)(If Phone is selected, Email shall be used for communication that cannot be sent via phone.)

Mail Email Phone Facsimile

Email address:

Email Notifications: Yes No

Fax Number:

PRIMARY FAMILY MAILING ADDRESS:Write “As Above” if the same as Family Home Address

No. & Street or PO Box

Suburb:

State: Postcode:


PRIMARY FAMILY DOCTOR DETAILS:

Doctor’s Name Individual or Group Practice: (tick) Individual Group

No. & Street or PO Box No.:

Suburb:

State: Postcode:

Telephone Number Fax Number

Current Ambulance Subscription: (tick) Yes No Medicare Number:

PRIMARY FAMILY EMERGENCY CONTACTS:Name Relationship Telephone Contact Language Spoken

(Neighbour, Relative, Friend or Other) (If English Write “E”)

1

2

3

4

PRIMARY FAMILY BILLING ADDRESS:Write “As Above” if the same as Family Home Address

No. & Street or PO Box

Suburb:

State: Postcode:

Billing Email Adult A Adult B

Other (Please Specify)

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

The student lives with the Primary Family: (tick one)

Always Mostly Balanced Occasionally Never

Send Correspondence addressed to: (tick one) Adult A Adult B Both Adults Neither


DEMOGRAPHIC DETAILS OF STUDENT

In which country was the student born?

Australia Other (please specify): ______________________________________

Date of arrival in Australia OR Date of return to Australia: (dd-mm-yyyy) _____ / _____ / _____

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: (dd-mm-yyyy) _____ / _____ / _____

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 Yes (please specify):

Does the student speak English? (tick) Yes No

Is the student of Aboriginal or Torres Strait Islander origin? (tick one)

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

# State Arranged Out of Home Care - Students who have been subject to protective intervention by the Department of Human Services and live in alternative care arrangements away from their parents. These DHS-facilitated care arrangements include living with relatives or friends (kith and kin), living with non-relative families (foster families or adolescent community placements) and living in residential care units with rostered care staff.

Note: Special Schools – please go to section “Travel Details for Special Schools” to enter transport details.

Beginning of journey to school: Map Type Melway / VicRoads / Country Fire Authority / Other

Map Number X Reference Y Reference

Usual mode of transport to school: (tick)

Walking School Bus Train Driven Taxi

Bicycle Public Bus Tram Self Driven Other

If student drives themself to school: Car Reg. No. Distance to School in kilometres:

These questions are asked as a requirement of the Commonwealth Government. All schools across Australia are required to collect the same information.


SCHOOL DETAILS

Date of first enrolment in an Australian School: _____ / _____ / ______

Name of previous School/Kindergarten:

Years of previous education:What was the language of the student’s previous education?

Does the student have a Victorian Student Number (VSN)?

Yes.Please specify:

Yes, but the VSN is unknown No. The student has never been issued

a VSN.

Years of interruption to education:Is the student repeating a year? (tick)

Yes No

Will the student be attending this school full time? (tick) Yes No

If No, what will be the time fraction that the student will be attending this school? (i.e: 0.8 = 4 days/week)

Other school Name: Time fraction: 0. Enrolled: Yes No

Other school Name: Time fraction: 0. Enrolled: Yes No

CONDITIONAL ENROLMENT DETAILSIn some circumstances a child may be enrolled conditionally, particularly if the required enrolment documentation to determine the shared parental responsibility arrangements for a child is not provided. Please refer to the School Policy & Advisory Guide’s Admission page for more information (http://www.education.vic.gov.au/school/principals/spag/participation/Pages/admission.aspx).

Enrolment conditions

OFFICE USE ONLYHas the documentation been provided and retained on school records? Yes No

Have the conditions been met to complete the enrolment? Yes No


http://www.education.vic.gov.au/school/principals/spag/participation/Pages/admission.aspx

STUDENT ACCESS OR ACTIVITY RESTRICTIONS DETAILS

Is the student at risk? Yes No

Is there an Access Alert for the student? (tick)

Yes (If Yes, then complete the following questions and present a current copy of the document to the school.)

No (If No, move to the immunisation / medical condition details questions.)

Access Type: (tick) Parenting Order Parenting Plan Intervention Order Protection Order

Informal Carer Stat Dec DHHS Authorisation Witness Protection Program Order

Other

Describe any Access Restriction:

Is there an Activity Alert for the student? (tick) Yes No

If Yes, then describe the Activity Restriction:

OFFICE USE ONLYCurrent custody document placed on student file? Yes No


STUDENT MEDICAL DETAILSMEDICAL CONDITION DETAILS:

Does the student suffer from any of the following impairments? (tick)

Hearing: Yes No Vision Yes NoSpeech: Yes No Mobility: Yes No

Does the student suffer from Asthma? (tick) If No, please go to the Other Medical Conditions section Yes No

ASTHMA MEDICAL CONDITION DETAILS:Answer the following questions ONLY if the student suffers from any asthma medical conditions.

Please indicate if the student suffers from any of the following symptoms: (tick)

If my child displays any of these symptoms please: (tick)

Cough Inform Doctor Yes No

Difficulty Breathing Inform Emergency Contact Yes No

Wheeze Administer Medication Yes No

Exhibits symptoms after exertion Other Medical Action Yes No Tight Chest If yes, please specify:

Has an Asthma Management Plan been provided to School? Yes No

Does the student take medication? (tick) Yes No Name of medication taken:

Is the medication taken regularly by the student (preventive) 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: (tick) Student Nurse Teacher Other

Medication is stored: (tick) with Student with Nurse Fridge in Staff Room Elsewhere

Dosage time Reminder required? (tick) Yes No Poison Rating

OTHER MEDICAL CONDITIONS(More copies of the other medical condition forms are available on request from the school.)

Does the student have any other medical condition? (tick) Yes No

If yes, please specify:

Symptoms:

If my child displays any of the symptoms above please: (tick)

Inform Doctor Yes No Inform Emergency Contact Yes NoAdminister Medication Yes No Other Medical Action Yes No

If yes, please specify:

Does the student take medication? (tick) Yes No Name of medication taken:

Is the medication taken regularly by the student (preventive) 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: (tick) Student Nurse Teacher

Other

Medication is stored: (tick) with Student with Nurse Fridge in Staff Room Elsewhere

Dosage time Reminder required? (tick) Yes No Poison Rating

STUDENT DOCTOR DETAILSThe following details should only be provided if this student has a Doctor and/or Medicare number different to the Primary Family.


Doctor’s Name:

Individual or Group Practice: (tick) Individual Group

No. & Street or PO Box No.:

Suburb:

State: Postcode:

Telephone Number Fax Number

Student Medicare Number:

STUDENT EMERGENCY CONTACTSThis section should ONLY be filled out if THIS student has emergency contacts other than the Prime Family Emergency Contacts.

Name Relationship Language Spoken Telephone Contact(Neighbour, Relative, Friend or Other) (If English Write “E”)

1

2

Thank you for taking the time to complete this Student Enrolment form. We understand that the information you have provided is confidential and will be treated as such, but the details are required to enable staff to properly enrol your child at our school.

I certify that the information contained within this form is correct.

Signature of Parent/Guardian: Date: _____ / _____ / ______

Signature of Parent/Guardian: Date: _____ / _____ / ______


PARENTAL OCCUPATION GROUP CODESThe codes outlined below are to be used when providing family occupation details for enrolled students. This information is used for determining funding allocations to schools.

GROUP A Senior management in large business organisation, government administration and defence, and qualified professional s Senior Executive / Manager / Department Head in industry, commerce, media or other large organisationPublic Service Manager (Section head or above), regional director, health / education / police / fire services

administratorOther administrator (school principal, faculty head / dean, library / museum / gallery director, research facility director)Defence Forces Commissioned OfficerProfessionals - generally have 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)

GROUP B Other business managers, arts/media/sportspersons and associate professionalsOwner / Manager of farm, construction, import/export, wholesale, manufacturing, transport, real estate businessSpecialist 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, proof reader, sportsman/woman, 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, marketing / advertising

specialist, market research analyst, technical sales representative, retail buyer, office / project manager) Defence Forces senior Non-Commissioned Officer

GROUP C Tradesmen/women, clerks and skilled office, sales and service staffTradesmen/women generally have completed a 4 year Trade Certificate, usually by apprenticeship. All tradesmen/women are

included in this groupClerks (bookkeeper, bank / PO clerk, statistical / actuarial clerk, accounting / claims / audit clerk, payroll clerk, recording /

registry / filing clerk, betting clerk, stores / inventory clerk, purchasing / order clerk, freight / transport / shipping clerk, bond clerk, customs agent, customer services clerk, admissions clerk)

Skilled office, sales and service staff: 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 / child care worker, nanny, meter reader, parking inspector, postal worker, courier,

travel agent, tour guide, flight attendant, fitness instructor, casino dealer/supervisor)

GROUP D Machine operators, hospitality staff, assistants, labourers and related workersDrivers, mobile plant, production / processing machinery and other machinery operatorsHospitality 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 (trades’ assistant, school / teacher's aide, dental assistant, veterinary nurse, nursing assistant,

museum / gallery attendant, usher, home helper, salon assistant, animal attendant)Labourers and related workers

Defence Forces - ranks below senior NCO not included above 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


BERWICK LODGE PRIMARY SCHOOL

Confidential Medical Report for School Excursions

The school will use this information is your child is involved in a medical emergency. All information is held in confidence.Parents are responsible for all medical costs if a student is injured on a school approved excursions unless the Department of Education is found liable (liability is not automatic). Parents can purchase student accident insurance cover from a commercial insurer if they wish to.This medical form must be current when the excursion is held.

Child’s Name:

Date of Birth: Grade:

Parent/Guardian’s Full Name(s):

Address: _

Emergency Telephone After Hours:

Business Hours:

Mobile:

Name & Address of Family Doctor:

Ambulance Subscriber: Yes No Subscriber Number:

Medicare Number: Exp Date: ____/_____ Child’s Ref No:

Medical/Hospital Insurance Fund: Contribution Number:

Are there any access restrictions that apply to this student? Yes No

If Yes, have you provided a copy of the court documents to the school? Yes No

Please tick if your child suffers any of the following:

Anaphylaxis Travel Sickness Dizzy Spells

Asthma Heart Condition Migraine

Epilepsy Fits of any type Blackouts

Diabetes Toileting Issues Other:


Allergies to:

Nuts Other Foods:

Penicillin Other Drugs:

Other Allergies:

What special care is recommended?

EpiPen Required

Tetanus Immunisation

Last tetanus immunisation was If over ten years since last immunisation please tick if booster is to be arranged by parents before the excursion. Booster Date:

CAMP INFORMATION - PREVIOUS EXPERIENCEIs this the first time your child has been away from home?Y N

Has your child attended camp previously? Y N

TABLETS & MEDICINE

Is your child currently taking tablets and/or medication? Yes No Does this medication need to be taken whilst on this excursion? Yes No

If YES, please state the name of medication, dosage etc:

All medications (other than asthma puffers) MUST be handed to the teacher in charge prior to leaving, with your child’s name, the dose to be taken and when it should be taken (these will be kept in the first aid centre and distributed as required). Please do not allow children to be in possession of any medicine while on excursions.

MEDICAL CONSENTWhere the teacher in charge of the excursion is unable to contact me, or it is otherwise impracticable to contact me, I authorise the teacher in charge to:

Consent to my child receiving any medical or surgical attention deemed necessary by a medical practitioner.

Administer such first aid as the teacher in charge judges to be reasonably necessary.

Parent/Guardian Name:

Parent/Guardian Signature:

Date:


COMPUTER NETWORK, INTERNET AND STUDENT IMAGE WORK PUBLICITYACCEPTABLE USE AGREEMENT FOR THE INTERNET AND DIGITAL TECHNOLOGIES

BERWICK LODGE PRIMARY SCHOOL believes the teaching of Cybersafe and responsible online behaviour is essential in the lives of students and is best taught in partnership between home and school.

21st century students spend increasing amounts of time online, learning and collaborating. To be safe online and to gain the greatest benefit from the opportunities provided through an online environment, students need to do the right thing by themselves and others online, particularly when no one is watching.

Safe and responsible behaviour is explicitly taught at our school and parents/carers are requested to reinforce this behaviour at home.

Part A - School support for the safe and responsible use of digital technologies

BERWICK LODGE PRIMARY SCHOOL uses, DEECD supported Blogs, Edmodo, Internet and digital technologies as teaching and learning tools. We see the Internet and digital technologies as valuable resources, but acknowledge they must be used responsibly.

Your child has been asked to agree to use the Berwick Lodge PS Blogs, Edmodo, Internet and mobile technologies responsibly at school. Parents/carers should be aware that the nature of the Internet is such that full protection from inappropriate content can never be guaranteed.

At BERWICK LODGE PRIMARY SCHOOL we will:

have policies in place that outline the values of the school and expected behaviours when students use digital technology and the internet

provide a filtered internet service provide access and model appropriate use of class and individual blogs, Edmodo and the internet. provide supervision and direction in online activities and when using digital technologies for learning support students in developing digital literacy skills (e.g. the Berwick Lodge Student Hour Radio Show, Blogs,

Edmodo groups and Skype partnerships) have a cybersafety program at the school which is reinforced across the school use mobile technologies for educational purposes (e.g. blogs, podcasts, videos or photos from excursions) work with students to outline and reinforce the expected behaviours while online using Blogs, Edmodo and

other online sites. reinforce that cybersafe and responsible behaviours are expected in their school use of digital technology and

internet

Part B - Student Agreement - When I use digital technology I agree to: be a safe, responsible and ethical user whenever and wherever I use it support others by being respectful in how I communicate with them and never write or participate in online

bullying (this includes forwarding messages and supporting others in harmful, inappropriate or hurtful online behaviour)

talk to a teacher if I feel uncomfortable or unsafe online or see others participating in unsafe, inappropriate or hurtful online behaviour

seek to understand the terms and conditions of websites and online communities and be aware that content I upload or post is my digital footprint

protect my privacy rights and those of other students by not giving out personal details including full names, telephone numbers, addresses and images

use the internet for educational purposes and use the equipment properly use social networking sites for educational purposes and only as directed by teachers


abide by copyright procedures when using content on websites (ask permission to use images, text, audio and video and cite references where necessary)

think critically about other users’ intellectual property and how I use content posted on the internet. not interfere with network security, the data of another user or attempt to log into the network with a user

name or password of another student not reveal my password to anyone except the system administrator or the teacher not bring or download unauthorised programs, including games, to the school or run them on school computers

When I use my mobile phone, iPad, iPod or other mobile device I agree to: follow the policy of the school detailed in the current Parent Information Handbook protect the privacy of others and never post or forward private information about another person only take photos and record sound or video when it is part of an approved lesson seek permission from individuals involved before taking photos, recording sound or videoing them seek appropriate (written) permission from individuals involved before publishing or sending photos, recorded

sound or video to anyone else or to any online space Be respectful in the photos I take or video I capture and never use these as a tool for bullying.

This Acceptable Use Agreement also applies during school excursions, camps and extra-curricula activities. I acknowledge and agree to follow these rules. I understand that my access to the internet and mobile technology at school will be renegotiated if I do not act responsibly.

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ACCEPTABLE USE AGREEMENT FOR INTERNET AND DIGITAL TECHNOLOGIES

Student Name: Year Level:

I have read the Acceptable Use Agreement carefully and understand the significance of the conditions and agree to abide by these conditions. I understand that any breach of these conditions will result in internet and mobile technology access privileges being suspended or revoked.

Student Signature: Date:

Parent/Guardian Name:

Parent/Guardian Signature:

If you have any concerns about this agreement or ideas for making the agreement better contact a member of the Principal Class. For further Support with online issues students can call Kids Helpline on 1800 55 1800. Parents/carers call Parentline 132289 or visit http://www.cybersmart.gov.au/report.aspx


http://www.cybersmart.gov.au/report.aspx

STUDENT IMAGE AND WORK PUBLICITY PERMISSION FORMEffective February 2018

At Berwick Lodge Primary School our students are involved in a range of occasions, events and activities that parents & guardians are invited to attend. At some of these events, photography and video recording is not permitted due to copyright or venue restrictions. On other occasions where these restrictions are not applicable, parents and guardians may be permitted to take images of their children as they take part in special school activities. While parents/guardians will focus on their child, other students may also be taking part in the event, such as a musical performance. At times, students may also be permitted to take photos during special activities such as school camps.

The teacher in charge of the activity will inform families beforehand if photos or videos are to be allowed, and any images that are recorded must be used for personal family use only. Parents should also inform other family members of the school’s policy on the taking of photos/videos. Berwick Lodge Primary School will not be held responsible for the actions of the school community.

Throughout the year there are many occasions, events and activities that we highlight in the media, on our website and in class blogs. We also involve children in school promotional activities such as brochures, advertisements and on our website. Your permission is required for your child’s photograph or work to appear in newspapers, brochures, advertisements, and blogs or on our website, our Facebook page and our other social media apps (eg: Twitter, YouTube). This permission also includes video streaming of classroom activities to our YouTube channel.

Please note that the use of student’s photographs or work is subject to strict privacy conditions. For example, a photograph of our House Captains in the local newspaper or on the Internet would include only the children’s first names. In all cases where children’s photographs are being used in promotional only material, such as advertisement brochures and on our website no identifying information such as surnames are included.

As part of our collaborative work process between students and teachers, we use collaboration tools such as Google Docs, Studyladder and Edmodo. Please note that some of this data could possibly be stored on servers world-wide.

This form must be completed by all parents/guardians on their child’s enrolment at the school. It will be placed in your child’s class file and will apply for the duration of their enrolment at our school unless an updated form is issued. If parents wish to change the authorisation details of this form at any time then they should contact the school.

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STUDENT IMAGE AND WORK PUBLICITY PERMISSION FORM – FEBRUARY 2018

STUDENT’S NAME: GRADE:

I give permission for my son/daughter to be photographed for publication for special events and achievements. eg: Local newspaper, newsletter, school magazine and calendar.

YES NO

I give permission for my child/ren to be photographed for publication for promotional material for the school. E.g.: School brochures, advertisements and school websites.

YES NO

I give permission for my child/ren’s work and photographs to appear on the Berwick Lodge Primary School website (including our class blogs and school newsletter), our Facebook Page and our other social media apps as well as video streaming to our YouTube channel.

YES NO

I give permission for my child/ren’s to use collaboration tools such as Google Docs, Studyladder and Edmodo.YES NO

Parent/Guardian Signature: Date:


CONSENT FORM – HEAD LICE INSPECTIONSThe occurrence of head lice (Pediculosis) infestation is an ever-increasing problem that schools face today. The school is aware that this can be a sensitive issue and is committed to maintaining student confidentiality and avoiding stigmatisation.

Before any inspections are conducted, staff will explain to all students what is being done and why, and it will be emphasised to students that the presence of head lice in their hair does not mean that their hair is less clean than anyone else’s. It will also be pointed out that head lice can be itchy and annoying and if you know you have got them, you can do something about it.

Any physical head lice inspection of students will be undertaken by a trained person approved by the principal and school council.

Persons authorised by the school principal (e.g. teachers) may also visually check your child’s hair for the presence of head lice, when it is suspected that head lice may be present. They do not physically touch the child’s head during a visual check, therefore permission is not required.

In cases where head lice are found, the student’s class teacher will be notified. The school will send a written notice home with the child and provide parents with comprehensive advice about the use of safe treatment practices which do not place children’s health at risk.

Please note that health regulations require that where a child has head lice, that child should not return to school until appropriate treatment has commenced. A child with head lice can be treated one evening and return to school the next day, even if there are still some eggs present.

The management of head lice infestation works best when all children are involved in our screening program.

This form must be completed by all parents/guardians on their child’s enrolment at Berwick Lodge Primary School. It will be placed in your child’s file and will apply for the duration of their enrolment at our school. Please inform the school in writing if you no longer wish to provide consent for the school to undertake head lice inspections for your child.

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CONSENT FORM—HEAD LICE INSPECTIONS

Student’s Name: Grade:

I give my consent for my child to participate in the physical head lice inspection program for the duration of their schooling at Berwick Lodge Primary School.

I do not give consent for my child to participate in the physical head lice inspection program for the duration of their schooling at Berwick Lodge Primary School.

Parent/Guardian Full Name:



SCHOOL COMMUNITY CODE OF CONDUCT

Rationale

At Berwick Lodge Primary School we promote the values that are in keeping with school’s mission statement. All students, parents, teachers and staff have the right to be safe, and feel safe, in their school community. With this right comes the responsibility to be law-abiding citizens and to be accountable for actions that intimidate or put at risk the safety of others or oneself. This includes behaviour that may be considered anti-social.

For the purpose of this Code of Conduct “School Community” comprises the principal, staff, coaches, parents, guardians, step-parents, relatives, friends, supporters, carers and invitees of the school, who attend at the school, or elsewhere, for the purposes of visiting, viewing, participating, supporting or being present for any official, sporting or social activity held by or for the benefit of the School and its students. (There is a separate “Student Code of Conduct” that all applies to all students from Prep to Grade 6.)

The School Community Code of Conduct sets clear standards of behaviour that are expected of members of the school community. It specifies the consequences for any member of the school community who does not comply with those standards of behaviour, whether those persons are on the school’s property, in transit or at another location for the purpose of any school-authorised events or activities.

Aims

For all members of the school community: to be treated with respect and dignity to be safe and feel safe to behave with respect, civility and in the manner of a responsible citizen.

Implementation

This Code of Conduct is a guide for all members of the school community about the standards of behaviour that are acceptable in the school environment or when attending any official, social or sporting function or activity of or relating to the school or in any location at which the school is represented.

As a minimum, all school community members must:

Respect and comply with all applicable Commonwealth and State laws Demonstrate honesty and integrity Respect differences in people, their ideas and opinions Treat one another with dignity and respect at all times, especially when there is a disagreement


Respect and treat others fairly, regardless of their race, ancestry, place of origin, colour, ethnicity, origin, citizenship, religion, gender, sexual orientation, age or disability

Respect the legal and moral rights of others Show the proper care and regard for school property and the property of others Take appropriate measures to help those in need Respect persons who are in position of authority Respect the need of others to work in an environment of learning and teaching Not cause, inflict or encourage others to verbally abuse, threaten or inflict bodily harm on another

person by any physical aggression or any other forms of bullying Not use any object to threaten or intimidate any other person Not cause injury to any person by use of any object Not be in the possession of, under the influence of or provide others with, alcohol or illegal drugs. Seek staff assistance, if necessary, to resolve conflict peacefully. No parent or guardian should ever directly approach a student regarding a conflict. If a parent or

guardian has a concern, always seek staff assistance.

Co-curricular Activities

This part of the Code of Conduct specifically deals with attendance at co-curricular (eg: sport, drama, music) activities. The following are statements of principle with which our school community are expected to comply:

Students should always be encouraged to play by the rules Young people should be taught that honest effort is as important as victory, so the results of each

game are accepted Never ridicule or yell at any student for making a mistake or losing a game Remember that young people learn best by example. Applaud good play by both the school team

and by members of the opposing team Do not publicly question the referee or game official’s judgement or his/her honesty Support all efforts to remove verbal and physical abuse from co-curricular activities Recognise the value and importance of volunteer coaches, managers and referees.

Social Media

This part of the Code of Conduct specifically deals with the use of social media (eg: Facebook, Twitter) by the school community. The following are guidelines with which our school community are expected to comply:

Do not use social media to intimidate, threaten or bully Do not cause, inflict or encourage others to verbally abuse Do not use social media to promote personal agendas Do not use social media to convey disparaging remarks about the school

Breach of this Code of Conduct

The consequences to a member of the school community for breaching this Code of Conduct will be determined at the Principal’s discretion. These consequences include any one or more of the following:

The school may ban any member of the school community from attending any co-curricular activity The school may ban any member of the school community from being on the school grounds in

general.


The school may direct that any parent may only communicate with members of the teaching staff through a nominated school representative.

The school may take such other steps as it may determine appropriate according to the nature of the breach.

Date Passed by School Council

The School Community Code of Conduct Policy was passed by School Council in September 2019.

Review Period

The Management Sub-Committee will be responsible for coordinating and planning the review of the School Community Code of Conduct policy, under the auspices of School Council. The Policy will be reviewed every three years.

We ask parents to sign the slip below to acknowledge that they have received the School Community Code of Conduct. Please return this acknowledgement slip with your enrolment forms.

If you have any queries, please do not hesitate to contact me.

Yours sincerely,

Henry GrossekPRINCIPAL

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SCHOOL COMMUNITY CODE OF CONDUCT

Eldest Child’s Name: Grade:

I (print name) have received the School Community Code of Conduct.



Documents

Student Enrolment Form - berwicklodgeps.vic.edu.au › wp-content › ... · Web viewBerwick Lodge Primary School. 145 Mansfield Street, Berwick. PO Box 454, Berwick 3806. Telephone: