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Attachment 1
Expression of Interest - STUDENT ENROLMENT FORM
For enrolment in a Western Australian Public School
This form is to be completed for children who are not currently enrolled at the school in the previous year and for all Pre Primary students. For students in the compulsory years of schooling who were enrolled in the previous year, please inform the school directly if there are changes needed to update the form. Please read the accompanying Parent information about Enrolment in a Western Australian public school before lodging the Enrolment Form with the school.
STUDENT DETAILS
Surname
*
First
Last
Previous Surname (if applicable)
First Name
*
Other Names (if applicable)
First
Last
Date of Birth
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
YYYY
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
*
Male
Female
Other
Current Year Level
*
Unenrolled
Kindergarten
Foundation
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Previous School (if applicable)
Student lives with:-
*
Both Parents
Parent/Guardian/Carer 1
Parent/Guardian/Carer 2
Independent Minor
Other
Name
*
First
Last
Does the student have siblings attending MSOTA?
*
Yes
No
Sibling Name
Does the student have access to a computer or laptop?
*
Yes
No
Does the student have access to an internet connection?
*
Yes
No
STUDENT DETAILS - ADDITIONAL INFORMATION
First
Last
First
Last
Is the student to be withdrawn from religious instruction?
No
Yes
Is the student's descent
*
Aboriginal
Torres Strait Islander (TSI)
Both Aboriginal and TSI
Neither Aboriginal or TSI
Is the student an Australian Citizen/Permanent Resident?
No
Yes
Name
First
Middle
Last
Does the sudent receive any of the following allowances?
Youth Allowance
Assistance for Isolated Children (AIC)
Abstudy
PARENT/GUARDIAN/CARER 1 DETAILS
Parent/Guardian/Carer 1
Title
Mr
Mrs
Miss
Ms
Name
*
First
Middle
Last
Please indicate relationship to the student
*
Please indicate whether you have the
*
Day to day care of the student
Long term care of the student
Fees and Charges
*
Yes
No
If NO, who is responsible?
*
Residential Address
*
Postal Address
*
Contact Numbers
First
Last
Email
*
Occupation/Workplace Location
First
Last
Do you speak a language other than English at home?
No, English only
Yes
Please specify which language is spoken most often
*
What is the highest year of primary or secondary school you completed?
*
Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent or below
If you did not attend school, mark 'Year 9 or equivalent'.
What is the level of the highest qualification you have completed?
*
Bachelor degree of above
Advance diploma/Diploma
Certificate I to IV
No non-school qualification
What is your occupation group?
*
1
2
3
4
Please select the appropriate parental occupation group from the list provided in ATTACHMENT 1. If you are not currently in paid work, but have had a job in the last 12 months, please use your last occupation. However, if you have not been in paid work in the last 12 months, enter ‘8’ above). ATTACHMENT 1 can be found at the top of the page.
Parent/Guardian/Carer 2 Details
Parent/Guardian/Carer 2
Yes
Title
Mr
Mrs
Miss
Ms
Name
*
First
Middle
Last
Please indicate relationship to the student
*
Please indicate whether you have the
*
Day to day care of the student
Long term care of the student
Fees and Charges
*
Yes
No
If NO, who is responsible?
*
Residential Address
*
Postal Address
*
Contact Numbers
First
Last
Email
*
Occupation/Workplace Location
First
Last
Do you speak a language other than English at home?
No, English only
Yes
Please specify which language is spoken most often
*
What is the highest year of primary or secondary school you completed?
*
Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent or below
If you did not attend school, mark 'Year 9 or equivalent'.
What is the level of the highest qualification you have completed?
*
Bachelor degree of above
Advance diploma/Diploma
Certificate I to IV
No non-school qualification
What is your occupation group?
*
1
2
3
4
Please select the appropriate parental occupation group from the list provided in ATTACHMENT 1. If you are not currently in paid work, but have had a job in the last 12 months, please use your last occupation. However, if you have not been in paid work in the last 12 months, enter ‘8’ above).
Other Contact Details
Title
Mr
Mrs
Miss
Ms
Name
First
Last
Please indicate relationship to the student
Address
Contact Numbers
First
Last
Email
Occupation/Workplace Location (copy)
First
Last
Please advise the school if you would like additional contacts recorded
Emergency Contacts
Indicate in order of preference
Name
*
First
Middle
Last
Emergency Contact 1
First
Middle
Last
First
Middle
Last
CONFIDENTIAL
Is this student subject to any court orders in respect to their care, welfare and development?
*
No
Yes
Please supply and attached supporting documentation
File Upload
File will be uploaded once the Submit button is pressed.
Is this student in the care of the Department for Child Protection and Family Support;s (CPFS) Director General?
*
No
Yes
Please specify the name of the CPFS Case Manager, their CPFS District and their contact number
CONSENT FORM
At Meekatharra School of the Air, we aim to offer your child the wildest range of learning activities whenever possible. This form asks you to consent (or otherwise) to your child’s participation / use / access to several aspects of the school program. At all times we make the very best efforts to exercise exemplary standards in respect of duty of care.
Media Consent
*
Yes, I give consent to my child to have his/her image and/or work published as described below
No, I do not give consent
Children’s images and/or their work are often published to recognise excellence or effort and may appear in newspapers, on the internet, in newsletters or on film or video. Their first names may also be included but no contact details are provided. Work/images captured by the school will be kept for no longer than is necessary for the purposes outlined above and will be stored and disposed of securely.
Viewing Consent
*
Yes, I consent to my child viewing items with a ‘PG’ rating if deemed suitable by the teacher and school administration.
No, I do not give consent
Children often watch videos / DVDs / television documentaries as part of their learning. Almost always these are ‘G’ rated and don’t require consent. Very occasionally something with a ‘PG’ rating is appropriate for which we would need parental permission.
Excursions
*
Yes, I consent to my child participating in teacher supervised local excursions which may involve short walks to and from the school
No, I do not give consent
Children occasionally walk within the local area for minor excursions under the supervision of the teacher and attend activities in local parks, nature reserves, another school, city council library or shopping centre. On all occasions, parents will be notified of the local excursion.
Schoolzine, Website and The Aerial Magazine
*
Yes, I give consent for you to publish the following on the Schoolzine website and in the MSOTA yearly school magazine, The Aerial.
No, I do not give consent
Schoolzine is a web-based school newsletter delivery system, delivering newsletters via email to parents. Included in our Schoolzine newsletters, teachers display student work and photos of activities at the school, such as camps. Our policy is to only use the child's first name when displaying work or photographs.
Please choose options that you consent to MSOTA and Schoolzine using in their publications
Student Photo
Parent/Home Tutor Photo
First Name
Station Name
Student Work Samples
Other
Please give details
Declaration
I agree that the information provided in this document is true and correct. I agree that if any of the information changes, I will notify the school immediately of the changes.
*
Additional Information
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