Student Enrolment Form - Brighton Secondary School

PARENT 1/ LEGAL GUARDIAN 1(Adult with whom the student primarily lives and the first contact personin the case of emergency)PARENT 2/GUARDIAN 2(Living at same address as student)MR/MRS/MS/OTHER:MR/MRS/MS/OTHER:FAMILY NAME:FAMILY NAME:GIVEN NAMES:GIVEN NAMES:SEX: MALE/FEMALE RELATIONSHIP TO STUDENT:SEX: MALE/FEMALE RELATIONSHIP TO STUDENT:OCCUPATION:EMPLOYMENT STATUS:OCCUPATION:EMPLOYMENT STATUS:*WHAT IS THE OCCUPATION GROUP OFPARENT 2/GUARDIAN 2?*PLEASE SELECT THE APPROPRIATE PARENTAL OCCUPATION GROUP.If the person is not currently in paid work but has had a job in the last 12 monthsor has retired in the last 12 months, please use the person’s last occupation.If the person has not been in paid work in the last 12 months, enter 8 above.*WHAT IS THE OCCUPATION GROUP OFPARENT 2/GUARDIAN 2?*PLEASE SELECT THE APPROPRIATE PARENTAL OCCUPATION GROUP.If the person is not currently in paid work but has had a job in the last 12 monthsor has retired in the last 12 months, please use the person’s last occupation.If the person has not been in paid work in the last 12 months, enter 8 above.WORK LOCATION:WORK LOCATION:WORK PHONE NUMBER:MOBILE PHONE NUMBER:WORK PHONE NUMBER:MOBILE PHONE NUMBER:EMAIL ADDRESS: (for newsletters and school alerts)* WHAT IS THE HIGHEST YEAR OF PRIMARY OR SECONDARYSCHOOL THE PARENT 1/GUARDIAN 1 HAS COMPLETED?For persons who never attended school, select ‘year 9 or equivalent or below’.n YEAR 12 OR EQUIVALENT 4n YEAR 11 OR EQUIVALENT 3n YEAR 10 OR EQUIVALENT 2n YEAR 9 OR EQUIVALENT 1* WHAT IS THE LEVEL OF THE HIGHEST QUALIFICATION THEPARENT 1/GUARDIAN 1 HAS COMPLETED?n BACHELOR DEGREE OR ABOVE 7n ADVANCED DIPLOMA/DIPLOMA 6n CERTIFICATE I TO IV (INCLUDING TRADE CERTIFICATE) 5n NO NON-SCHOOL QUALIFICATION 8EMAIL ADDRESS: (for newsletters and school alerts)* WHAT IS THE HIGHEST YEAR OF PRIMARY OR SECONDARYSCHOOL THE PARENT 2/GUARDIAN 2 HAS COMPLETED?For persons who never attended school, select ‘year 9 or equivalent or below’.n YEAR 12 OR EQUIVALENT 4n YEAR 11 OR EQUIVALENT 3n YEAR 10 OR EQUIVALENT 2n YEAR 9 OR EQUIVALENT 1* WHAT IS THE LEVEL OF THE HIGHEST QUALIFICATION THEPARENT 2/GUARDIAN 2 HAS COMPLETED?n BACHELOR DEGREE OR ABOVE 7n ADVANCED DIPLOMA/DIPLOMA 6n CERTIFICATE I TO IV (INCLUDING TRADE CERTIFICATE) 5n NO NON-SCHOOL QUALIFICATIONS 8IN WHICH COUNTRY WAS THEPARENT 1/GUARDIAN 1 BORN?IF NOT BORN IN AUSTRALIA, WHAT WAS THEDATE THE PARENT 1/GUARDIAN 1 ARRIVED INAUSTRALIA?* DOES THE PARENT 1/GUARDIAN 1 SPEAK ALANGUAGE OTHER THAN ENGLISH AT HOME?n NOn YESIN WHICH COUNTRY WAS THEPARENT 2/GUARDIAN 2 BORN?IF NOT BORN IN AUSTRALIA, WHAT WAS THEDATE THE PARENT 2/GUARDIAN 2 ARRIVED INAUSTRALIA?* DOES THE PARENT 2/GUARDIAN 2 SPEAK ALANGUAGE OTHER THAN ENGLISH AT HOME?n NOn YESIf yes, main language spoken at homeIf yes, main language spoken at home* DOES THIS PARENT OR GUARDIAN REQUIREAN INTERPRETER?n NOn YES* DOES THIS PARENT OR GUARDIAN REQUIREAN INTERPRETER?n NOn YES* DOES THE PARENT 1/GUARDIAN 1 IDENTIFYWITH A NON-ENGLISH SPEAKING CULTURE?n NOn YES* DOES THE PARENT 2/GUARDIAN 2 IDENTIFYWITH A NON-ENGLISH SPEAKING CULTURE?n NOn YESIf yes, which culture?If yes, which culture?* Explanation of the Occupational Groups appears on page 2 of the Advice to Parents brochure.

MAILING ADDRESSESMAILING ADDRESS (OF PARENT/GUARDIAN WITH WHOM STUDENT LIVES)RESIDENTIAL ADDRESS (IF DIFFERENT FROM MAILING ADDRESS)MAILING TITLE:MAILING TITLE:ADDRESS LINE 1:ADDRESS LINE 1:ADDRESS LINE 2:ADDRESS LINE 2:SUBURB/TOWNSUBURB/TOWNPOSTCODE:POSTCODE:COUNTRY: (IF NOT AUSTRALIA)COUNTRY: (IF NOT AUSTRALIA)FAMILY/HOME PHONE NUMBER:SILENT?n YESn NOFAMILY/HOME PHONE NUMBER:SILENT?n YESn NOSTUDENT MOBILE PHONE NUMBER:STUDENT EMAIL ADDRESS:OTHER PARENT/GUARDIAN/CARER NOT RESIDING AT SAME ADDRESS AS STUDENTMR/MRS/MS/OTHER:FAMILY NAME:ADDRESS:GIVEN NAMES:SUBURB/TOWNPOSTCODE:SEX: MALE/FEMALE RELATIONSHIP TO STUDENT:EMAIL ADDRESS:PHONE NUMBER:MOBILE PHONE NUMBER:SILENT? n YES n NO PLEASE INDICATE IF THIS PERSON WISHES TORECEIVE REPORTS AND/OR CORRESPONDENCEn REPORTSn NEWSLETTER ALERTn OTHER CORRESPONDENCEWORK PHONE NUMBER:If there is more than one person who would like to receive correspondence please attach details.INTERNATIONAL/OVERSEAS STUDENTS ONLYIF THE STUDENT IS AN OVERSEAS OR INTERNATIONAL FEE PAYING STUDENT WHO HOLDS A TEMPORARYAUSTRALIAN VISA, A COPY OF THE AUTHORITY TO ENROL AND OR PASSPORT MUST BE PROVIDED AT ENROLMENT.n INTERNATIONAL FEE PAYERn YESn NOAGENT:n EXCHANGE STUDENTn YESn NOSPONSORING ORGANIZATION:ESTIMATED LEAVING DATE:

EMERGENCY CONTACTS IF PARENT OR GUARDIAN CANNOT BE CONTACTEDPRIORITY 1:NAME:HOME PHONE NUMBER:SILENT?n YESn NORELATIONSHIP TO STUDENT:MOBILE PHONE NUMBER: WORK PHONE NUMBER: EXT:PRIORITY 2:NAME:HOME PHONE NUMBER:SILENT?n YESn NORELATIONSHIP TO STUDENT:MOBILE PHONE NUMBER: WORK PHONE NUMBER: EXT:PRIORITY 3:NAME:HOME PHONE NUMBER:SILENT?n YESn NORELATIONSHIP TO STUDENT:MOBILE PHONE NUMBER: WORK PHONE NUMBER: EXT:RELEVANT MEDICAL CONDITIONSDOES YOUR CHILD HAVE A DIAGNOSED MEDICAL CONDITION WHICH MIGHT NEED FIRST AID?IF YES, PLEASE TICK RELEVANT CONDITIONS (please provide details below)n YESn NOn SEVERE ALLERGIES n ASTHMA n HEART CONDITION n DIABETES n JOINT CONDITION n SEIZURESn OTHER, PLEASE SPECIFY/DETAILSDOES YOUR CHILD NEED EXTRA ROUTINE HEALTH SUPPORT?E.G. Support with medication management, continence care, psychiatric issuesIF YES, THE SCHOOL WILL NEED A HEALTH CARE PLAN FROM THE TREATING DOCTOR/HEALTH PROFESSIONAL.PLEASE ENSURE THIS PLAN IS ATTACHED.n YESn NOFAMILY DETAILSMEDICARE NUMBER † :DOES THIS FAMILY HAVEPRIVATE HEALTH INSURANCE? †IF YES, WITH WHICH PRIVATEHEALTH INSURANCE FUND? †n YESn NO†Enrolling parent or guardian may elect to not answer this question.DETAILS OF STUDENT’S DOCTORDOCTOR’S NAME:ADDRESS LINE 1:PHONE NUMBER: ADDRESS LINE 2:SUBURB/TOWNPOSTCODE:

TRANSPORT TO SCHOOLUSUAL MODE OF TRANSPORT: (walk, bus, cycle, car)SCHOOL BUS ROUTE – AM: STOP: TIME:SCHOOL BUS ROUTE – PM: STOP: TIME:VEHICLE REGISTRATION NUMBER (PARENT):VEHICLE REGISTRATION NUMBER (STUDENT):CONVEYANCE ALLOWANCE:EXPIRY DATE:FAMILY COURT ORDERSARE THERE ANY CURRENT COURT-SANCTIONED RESIDENCY, PARENTAL RESPONSIBILITY OR CONTACT ORDERSRELATING TO THIS STUDENT? If yes, please attach a copy of the order for the school’s records.ON WHAT DATE WAS THE ORDER ISSUED OR ON WHAT DATE IS THE ORDER DUE FOR REVIEW?n YESn NODETAILS:BROTHERS AND SISTERSNAME:SEX:n MALEn FEMALEDATE OF BIRTH:ATTENDS THISSCHOOL?n YESn NONAME:SEX:n MALEn FEMALEDATE OF BIRTH:ATTENDS THISSCHOOL?n YESn NONAME:SEX:n MALEn FEMALEDATE OF BIRTH:ATTENDS THISSCHOOL?n YESn NONAME:SEX:n MALEn FEMALEDATE OF BIRTH:ATTENDS THISSCHOOL?n YESn NONAME:SEX:n MALEn FEMALEDATE OF BIRTH:ATTENDS THISSCHOOL?n YESn NOOTHER SCHOOLS ATTENDEDLIST MOST RECENT SCHOOLS ATTENDED. IF UNSURE OF DATES, PLEASE ESTIMATE.SCHOOL: FROM: TO:SCHOOL: FROM: TO:ANY OTHER INFORMATION/COMMENTS (please attach more information if necessary)

CONSENT AND SUPPORT OF SCHOOL POLICIESTALENT RELEASE FORM FOR USE OF IMAGES FORPROMOTIONAL PURPOSESI: (PARENT’S/GUARDIAN’S NAME - PLEASE PRINT)ON BEHALF OF: (STUDENT’S NAME - PLEASE PRINT)1. consent to video footage/photos/other images of my child beingtaken by the Department of Education and Children’s Services stafffor a variety of public relations, communications and promotionalactivities, including for publications, promotional material, websitesand advertisements, for an undefined period of time2. acknowledge that any recording made by the Department of anyperformance of my child in connection with promotional activities isan authorised use of my child’s performance for the purposes of theCopyright Act 19683. understand that any video footage/photos/other images taken maybe shown in a public environment in South Australia, interstate and/or overseas4. agree that my child’s participation in promotional activities maybe edited at the sole discretion of the Department or school5. acknowledge that the Department is not obliged to include mychild in the promotional activities6. release the Department from any claim by me or anyoneon my behalf and arising out of my child’s appearance inpromotional activities7. acknowledge that there is to be no payment or further considerationpaid for my child’s performanceUNIFORMI AGREE TO ABIDE BY THE SCHOOL uniform POLICY AND TOPURCHASE AND WEAR THE BRIGHTON SECONDARY SCHOOLUNIFORM CORRECTLY.STUDENT’S SIGNATURE:USE OF EQUIPMENT, RESOURCES AND BOOKS ON LOANI agree to my child accessing resources, equipment and bookson loan from the school for the purpose of his/her studies atBrighton Secondary School.I agree that I will reimburse the school for damages caused,or loss incurred, by my child whilst using equipment, resourcesand books in the course of their studies.I have read the Brighton Secondary School Learning Technologiescode of conduct and am aware of the consequences fornon-compliance.STUDENT’S NAME:STUDENT’S SIGNATURE:DATE:PARENT’S/GUARDIAN’S SIGNATURE:SIGNED BY: (PARENT’S/GUARDIAN’S SIGNATURE)DATE:DETAILS OF PERSON RESPONSIBLE FOR BILLING(please advise the school should this information change)DATE:ENROLLING PARENT/GUARDIANI agree to support Brighton Secondary School Policies.NAME OF ENROLLING PARENT OR GUARDIAN 1:NAME:SIGNATURE:DATE:ADDRESS:NAME OF ENROLLING PARENT OR GUARDIAN 2:SUBURB/TOWNPOSTCODE:SIGNATURE:DATE:305 Brighton RoadNorth Brighton, SA 5048Phone 618 8375 8200Fax 618 8296 0949DECSAccredited SchoolESOSIESwww.brightonss.sa.edu.auINTERNATIONAL STUDENT PROGRAMSCRICOS provider number 00018A