Preparatory Enrolment

Preparatory Enrolment Application

Program *

Proposed year of entry eg: 2021 *

Family Name *

Given Names *

Preferred Name *

Date of Birth *

Gender *

Female Male Non-binary

Student's residency status *

Australian Citizen Permanent Resident Temporary Visa Holder

Nationality *

Country of Birth *

Date of arrival in Australia *

Language Spoken at Home (main language) *

Religion *

Australian School Entry Date: *

IS THE STUDENT OF ABORIGINAL OR TORRES STRAIT ISLANDER ORIGIN? *

No Yes, Aboriginal Yes, Torres Straight Islander Yes, both Aboriginal and Torres Straight Islander

Name of Step Father/Mother (If applicable) *

Are there any family court orders/parenting plans that have been issued in relation to the enrolling student? *

Yes No

Attach supporting documents (if applicable) *

Max file size: 20MB

has the child attended pre-school or child care? *

Yes No

name of Pre-School or child care centre *

Pre-School or child care centre phone *

how many days per week? *

Doctor's Name *

Doctor's Phone Number *

Doctor's Address *

Line 1

Line 2

City

State

Zip Code

Country

Student's Medicare number and position *

Private Health Fund (if applicable) *

allergies/ medical alert *

Attach Action Plan (if applicable) *

Max file size: 20MB

Other Medical conditions *

Yes No

If Yes, please specify *

Private Health Fund Number *

immunisations *

Fully immunised Partially immunised On a catch up plan Not immunised

Attach Immunisation History (if applicable) *

Max file size: 20MB

name of parent/guardian 1 *

First

Last

Email of Parent/Guardian 1 *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

religion *

Postal Address (if different from home address) *

Line 1

Line 2

City

State

Zip Code

Country

Country of birth *

Nationality *

Phone Number (mobile) *

Languages Spoken at Home *

Phone Number (Work) *

occupation *

Employer *

Are you an ex-student of Southside Montessori? *

Yes No

name of parent/guardian 2 *

First

Last

Email of parent/guardian 2 *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

religion *

nationality *

Phone Number (mobile) *

Postal Address (if different from home address): *

Line 1

Line 2

City

State

Zip Code

Country

country of birth *

languages spoken at home *

Phone Number (work) *

OCCUPATION *

EMPLOYER *

Are you an ex-student of Southside Montessori? *

Yes No

Please nominate a person who may be contacted in an emergency if parents cannot *

First

Last

relationship to student *

Phone Number *

number of other children in family *

Child 1 - Full Name *

child 2 - full name *

child 3 - full name *

child 4 - full name *

Child 1 - Date of Birth *

child 2 - date of birth *

child 3 - date of birth *

child 4 - date of birth *

Child 1 - School Year *

child 2 - school year *

child 3 - school year *

child 4 - school year *

Child 1 - School Attending *

child 2 - school attending *

child 3 - school attending *

child 4 - school attending *

Please list siblings you wish to enrol at Southside in the future (please include name & date of birth) *

If you have answered yes, please elaborate *

Please provide current copies of any diagnosis- must be within the last 18 months

Current Assessments *

Max file size: 20MB

If yes, has your child received support for this need? *

Does your child have an NDIS number- please provide *

Please outline the support provided *

Does your child suffer from any of the following:

please tick *

Sunscreen sensitivity Fits/ blackouts Fainting

PLEASE TICK *

Diabetes Sight/Hearing loss Heart conditions

plEASE TICK *

ADHD Eczema Hayfever

do you give permission for southside montessori school to access you child's previous school files? *

Yes No