ENROLMENT APPLICATION FORM

(Strictly Confidential)

    Student’s name
    Subject
    Date of birth
    Age
    Grade
    Gender
    Preferred Class Time and Day
    Does the Student wear spectacles in the Classroom:
    Parent’s Details
    Parent 1
    Parents Name:
    Address
    Postcode:
    Home telephone:
    Mobile:
    Work telephone:
    Fax:
    Email address:
    Parent 2
    Parents Name:
    Address
    Postcode:
    Home telephone:
    Mobile:
    Email address:
    Carer’sDetails (If Carer Supporting Application). STUDENT resides with parent/carer/other
    Carer’s name:
    Relationship to child:
    Home telephone:
    Mobile
    Email address: