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Student Enrolment Form 2021

Student Enrolment Application Part A

Tuart Rise Primary School
APPLICATION FOR ENROLMENT FORM
(For enrolment in a Western Australian Public School)
DECLARATION
The information and statements provided in this application for enrolment are true and accurate in relation to:
Name of child:
Name of person enrolling child:*
Prefix First Middle Last
Relationship to child:*
(Independent Minors and those aged 18 years or older may apply on their own behalf)
Phone (H):
Mobile:*
Signature*
By ticking this box I am confirming the above is true and correct
NOTE: Children may be enrolled in Kindergarten in one school only, either public or private. NOTE: In the event that statements made in this application later prove to be false or misleading, a decision on this application may be reversed. Information supplied may need to be checked by the school.
PERSONAL DETAILS (PLEASE TYPE ALL DETAILS BELOW)
If enrolling a Kindergarten student, Kindergarten (school) enrolling in:*
Please select the school in your catchment area if enrolling in Kindergarten.
Child's Name*
First Middle Last
Date of Birth*
Date Format: DD slash MM slash YYYY

DD/MM/YYYY
Sex*
- Male
- Female
Name of parent / responsible person:*
Prefix First Last
Residential Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nearest intersecting street:
Postal Address: (if different from residential address):
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone:
Mobile Phone:*
Email*
Are there any Family Court Orders regarding the day to day or long term care, welfare and development of the child?*
- Yes
- No
Is the child subject to access restriction? If yes, please specify and attach supporting documentation.*
- Yes
- No
Year level enrolling in:*
Start date: Beginning of school year 2021*
- Yes
- No
If NO, indicate start date:
If applicable, year level child is currently enrolled in:
If applicable, school at which the child is currently or was last enrolled:
Immunisation: you are required to provide this information when you apply to enrol your child. Is the child immunised?*
- Yes
- No
If yes, does the child have an Australian Immunisation Register (AIR) Immunisation History Statement that is not more than two months old?*
- Yes
- No
Will there be any brothers or sisters attending this school?
- Yes
- No
If Yes, Name and Year level:
Is your child currently under suspension from a school?
- Yes
- No
If YES, name of school:
Has your child ever been excluded from a school?
- Yes
- No
If YES, name of school:
Is your child a permanent resident of Australia?*
- Yes
- No
If No, please indicate date entered Australia
Visa Sub Class No:
Is either parent/guardian employed by the Australian Defence Force*
- Navy
- Army
- Airforce
- None
Does your child have a disability/medical condition? This information will assist the school principal with considering whether any specific or additional resources are required and available to assist the school with providing the best educational program for your child. Please indicate whether:*
- Physical
- Intellectual
- Other Medical conditions
- No
Please outline nature of disability/medical condition/s (or attach details).
Office Use Only
Application for Enrolment approved:
- Yes
- No
Signature of Principal / Delegate:
Date
Date Format: MM slash DD slash YYYY

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Student Enrolment Form 2021
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