Student Enrolment Form - Silverton Primary School

SILVERTON PRIMARY SCHOOL
STUDENT ENROLMENT INFORMATION – 2016
Computer Generated Student ID:
VSN:
STUDENT DETAILS
REGISTER
Number:
PERSONAL DETAILS OF STUDENT
Surname:
Title: (Miss Ms 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)
Mobile Number:
Fax Number:
 Yes
 No
OFFICE USE ONLY
Child’s Name and Birth Date proof sighted (tick)
Year
Level
Home
Group
 Yes
 No
Timetabling
Group
Enrolment Date:
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.:
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.
Last updated: Sep-10
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PRIMARY FAMILY DETAILS
NOTE: 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.
As the School Start Bonus will be sent to the ‘Primary Carer’ of Prep and Year 7 students, it is imperative that the legal
surname, legal first name and legal second name are recorded.
ADULT A DETAILS (PRIMARY CARER):
 Male
Sex (tick):
ADULT B DETAILS:
 Female
 Male
Sex (tick):
 Female
Title: (Ms, Mrs, Mr, Dr etc)
Title: (Ms, Mrs, Mr, Dr etc)
Legal Surname:
Legal Surname:
Legal First Name:
Legal First Name:
What is Adult A’s occupation?
What is Adult B’s occupation?
Who is Adult A’s employer?
Who is Adult B’s employer?
In which country was Adult A born?
 Australia
In which country was Adult B born?
 Other (please specify):
 Australia
 Other (please specify):

Does Adult A speak a language other than
English at home? (If more than one language is spoken at

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)
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)
No, English only
Yes (please specify):
Please indicate any additional
languages spoken by Adult B:
 Yes
 No
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
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’.)
have never attended school, mark ‘Year 9 or equivalent or below’.)
 Year 12 or equivalent
 Year 12 or equivalent
 Year 11 or equivalent
 Year 11 or equivalent
 Year 10 or equivalent
 Year 10 or equivalent
 Year 9 or equivalent or below
 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
 What is the level of the highest qualification the
Adult B has completed? (tick one)
 Bachelor degree or above
 Advanced diploma / Diploma
 Advanced diploma / Diploma
 Certificate I to IV (including trade certificate)
 Certificate I to IV (including trade certificate)
 No non-school qualification
 No non-school qualification
What is the occupation group of Adult A? Please select
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.
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
 If the person has not been in paid work for the last 12
months, enter ‘N’.
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
Preferred language of notices:
home:
Are you interested in being involved in school group
participation activities? (eg. School Council, excursions) (tick)
Last updated: Sep-10
 Adult A
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 Adult B
 Both
 Neither
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PRIMARY FAMILY CONTACT DETAILS
ADULT A CONTACT DETAILS:
ADULT B CONTACT DETAILS:
Business Hours:
Can we contact Adult A at work?
Business Hours:
Can we contact Adult B at work?
(tick)
Is Adult A usually home during
business hours? (tick)
 Yes
 No
 Yes
 No
(tick)
Is Adult B usually home during
business hours? (tick)
Work Telephone No:
Work Telephone No:
Other Work Contact
information:
Other Work Contact
information:
After Hours:
Is Adult A usually home AFTER
business hours? (tick)
 Yes
After Hours:
Is Adult B usually home AFTER
business hours? (tick)
 No
 Yes
 No
 Yes
 No
 Yes
 No
Home Telephone No:
Home Telephone No:
Other After Hours
Contact Information:
Other After Hours
Contact Information:
Adult A’s preferred method of contact: (tick one)
Adult B’s preferred method of contact: (tick one)
 Mail
 Mail
 Email
 Facsimile
 Email
Email address:
Email address:
Fax Number:
Fax Number:
 Facsimile
PRIMARY FAMILY M AILING ADDRESS:
Write “As Above” if the same as Family Home Address
No. & Street or PO Box
Suburb:
State:
Postcode:
PRIMARY FAMILY DOCTOR DETAILS:
Individual or Group Practice:
Doctor’s Name
(tick)
 Individual
 Group
No. & Street or PO Box No.:
Suburb:
State:
Postcode:
Telephone Number
Fax Number
Current Ambulance Subscription: (tick)
Last updated: Sep-10
 Yes
 No
Medicare Number:
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PRIMARY FAMILY EMERGENCY CONTACTS (OTHER THAN PARENTS):
Name
Relationship
Telephone Contact
Language Spoken
(If English Write “E”)
(Neighbour, Relative, Friend or Other)
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:
OTHER PRIMARY FAMILY DETAILS
Relationship of Adult A to Student: (tick one)
Relationship of Adult B to Student: (tick one)
 Parent
 Foster Parent
 Step-Parent
 Host Family
 Adoptive Parent
 Relative
 Friend
 Parent
 Self
 Step-Parent
 Other
 Adoptive Parent
 Foster Parent
 Friend
 Host Family
 Self
 Relative
 Other
The student lives with the Primary Family: (tick one)
 Always
 Mostly
Send Correspondence addressed to: (tick one)
 Balanced
 Adult A
 Occasionally
 Adult B
 Never
 Both Adults
 Neither
NOTE: Parents receiving a benefit from Centrelink and holding a current Health Care card or a current Pension
card may be entitled to receive the Education Maintenance Allowance. Information on eligibility and application
forms are available from the school office.
Last updated: Sep-10
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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)
_____ / _____ / _____
 Permanent
What is the Residential Status of the student? (tick)
 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):
 Yes
Does the student speak English? (tick)

 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
Map Number
Melway / VicRoads / Country Fire Authority / Other
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:
Student’s Religion:
Will the student participate in Religious Instruction classes? (tick)
 Yes
 No
 These questions are asked as a requirement of the Commonwealth Government. All schools across Australia are required to
collect the same information.
Last updated: Sep-10
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SCHOOL DETAILS
Date of first enrolment in an Australian School:
_____ / _____ / ______
Name of previous School or Kindergarten:
What was the language of the
student’s previous education?
Years of 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)
Will the student be attending this school full time? (tick)
 Yes
 No
 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 DETAILS
In 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 Section 4.1.2.6 of the Victorian
Government Schools Reference Guide for more information
(http://www.education.vic.gov.au/management/governance/referenceguide/default.htm).
Enrolment conditions


OFFICE USE ONLY
Has the documentation been provided and retained on school
records?
 Yes
 No
Have the conditions been met to complete the enrolment?
 Yes
 No
Last updated: Sep-10
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STUDENT ACCESS OR ACTIVITY RESTRICTIONS DETAILS
Is the student at risk?
Is there an Access Alert for the student? (tick)
Access Type: (tick)
 Court Order
 Yes
 No
 Yes (If Yes, then complete the
 No (If No, move to the immunisation
following questions and present a
current copy of the document to the
school.)
/ medical condition details questions.)
 Family Law Order
 Restraining Order
 Other
Describe any Access Restriction:
 Yes
 No
Current custody document placed on student file?  Yes
 No
Is there an Activity Alert for the student? (tick)
If Yes, then describe the Activity Restriction:
OFFICE USE ONLY
STUDENT MEDICAL DETAILS
MEDICAL CONDITION DETAILS:
Does the student suffer from any of the
following impairments? (tick)
Hearing:
 Yes
 No
Vision
 Yes
 No
Speech:
 Yes
 No
Mobility:
 Yes
 No
 Yes
 No
Does the student suffer from Asthma? (tick) If No, please go to the Other Medical Conditions section
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)
 Cough
If my child displays any of these symptoms please: (tick)
Inform Doctor
 Yes
 No
 Difficulty Breathing
Inform Emergency Contact
 Yes
 No
 Wheeze
Administer Medication
 Yes
 No
 Exhibits symptoms after exertion
 Tight Chest
Other Medical Action
 Yes
 No
 Yes
 No
If yes, please specify:
Has an Asthma Management Plan been provided to School?
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)
Indicate the usual dosage of
medication taken:
Dosage time
Last updated: Sep-10
 Response
Indicate how frequently
the medication is taken:
Medication is usually administered by: (tick)
Medication is stored: (tick)
 Preventative
 with Student
Reminder required? (tick)
 Student
 Nurse
 with Nurse
 Yes
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 No
 Teacher
 Fridge in Staff Room
 Other
 Elsewhere
Poison Rating
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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
 Yes
 Yes
 No
 No
If yes, please specify:
Symptoms:
If my child displays any of the symptoms above please: (tick)
 Yes
 Yes
Inform Doctor
Administer Medication
 No
 No
Inform Emergency Contact
Other Medical Action
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
 Preventative
response to symptoms? (tick)
Indicate the usual dosage of
Indicate how frequently the
medication taken:
medication is taken:
Medication is usually administered by: (tick)
 with Student
Medication is stored: (tick)
Dosage time
Reminder required? (tick)
 Student
with Nurse
 Yes

Teacher
 Fridge in Staff
Room
 Nurse
 No
 Response
 Other
 Elsewhere
Poison Rating
STUDENT DOCTOR DETAILS
The 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
Individual or Group Practice: (tick)
 Group
No. & Street or PO Box No.:
Suburb:
State:
Postcode:
Telephone Number
Fax Number
Student Medicare Number:
STUDENT EMERGENCY CONTACTS
This section should ONLY be filled out if THIS student has emergency contacts other than the Prime Family
Emergency Contacts.
Name
Relationship
Language Spoken
(Neighbour, Relative, Friend or Other)
(If English Write “E”)
Telephone Contact
1
2
Last updated: Sep-10
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The enrolment form information you provide is entered into the school’s computerised administrative
system for educational, administrative and reporting purposes. The information marked with the symbol
is also transferred to the Ultranet (an online learning environment across all Victorian schools) to set up
your child's profile in the Ultranet and for administrative and reporting purposes. Your child’s information
will be viewed only by authorised staff. More detail about the Ultranet and privacy is available in the
Ultranet guide provided to you. You may ask the school not to activate your child's profile in the Ultranet
however the information marked with
on this form will be provided to the Ultranet.
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 consent to the following for my child:
 In the event of illness or injury to my child whilst at school, on an excursion, or travelling to or from school;
I authorise the Principal or teacher-in-charge of my child, where they are unable to contact me, or it is
otherwise impracticable to contact me to my child receiving such medical or surgical attention as may be
deemed necessary by a medical practitioner or administer such first aid as the Principal or staff member
may judge to be reasonably necessary
 Having routine inspections for head lice (these will be done by qualified people appointed by the school)
 Taking part in local excursions (this is a blanket approval for the child’s entire schooling at Silverton
Primary)
 Being involved in the many forms of technology that the school participates in such as: interactive
television, radio broadcasts, print and television media, and the school website; and having their work or
image displayed in any or all of these mediums as covered under School Council approved policies
If you have concerns or queries of any of the above please ask to discuss them with the schools’ Assistant
Principal.
I certify that the information contained within this form is correct.
Signature of Parent/Guardian:
Last updated: Sep-10
Date: _____ / _____ / ______
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PARENTAL OCCUPATION GROUP CODES
The 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
professionals
Senior Executive / Manager / Department Head in industry, commerce, media or other large organisation
Public Service Manager (Section head or above), regional director, health / education / police /
fire services administrator
Other administrator (school principal, faculty head / dean, library / museum / gallery director, research facility director)
Defence Forces Commissioned Officer
Professionals - 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 professionals
Owner / Manager of farm, construction, import/export, wholesale, manufacturing, transport, real estate business
Specialist 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 staff
Tradesmen/women generally have completed a 4 year Trade Certificate, usually by apprenticeship. All
tradesmen/women are included in this group
Clerks (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 workers
Drivers, mobile plant, production / processing machinery and other machinery operators
Hospitality 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
Parental Occupation Group Codes
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