Enrolment -


Enrolment Information
Day
Month
Year
The student's academic year level at entry
Student Details

First name
Middle name/s
Last name
 
Please enter your legal name as it appears on your Birth Certificate.
First name
Middle name/s
Last name
Day
Month
Year
Select gender
The Name of the School your student is currently attending
Residence A / Primary Contact Details*

Please type your primary residence addresss in the above address search
Flat/Unit
Street Number
Street Name
Suburb
Post Code
Town/City

Residence A - Caregiver 1

e.g. Mother's name
e.g. dsmith@gmail.com
e.g. 022 123 4567
e.g. 06 123 4567
e.g. 06 123 4567
Relationship to the student

Residence A - Caregiver 2

e.g. Father's name
e.g. bsmith@gmail.com
e.g. 022 123 4567
e.g. 06 123 4567
e.g. 06 123 4567
Relationship to the student
Please tick if the student resides at another address at times
Health Details

List any medical problems including hearing, allergies and diagnosed conditions
Special needs, disability or learning difficulties
Emergency Contact

Emergency Contact 1
e.g. 06 123 4567
e.g. 022 123 4567
e.g. Teacher at Waitara High School
e.g. Grandmother
Emergency Contact 2
e.g. 06 123 4567
e.g. 022 123 4567
Occupation
e.g. Grandfather
Special Interests