Forms to be returned with this enrolment form

Forms to be returned with this enrolment form
Birth Certificate
Medical Form
Immunisation Record
ENROLMENT FORM
‘The Really Important Stuff’
Burdekin Christian College Early Learning Centre
Optional – Enrolment Process feedback form
Please provide evidence of your Concession Card/Health Care Card
____________________________
I have received and read the following additional forms
We aim to provide an education that encourages students to develop all their individual talents, to learn to treat
each other with respect and dignity, and to teach all aspects of the curriculum in the light of God’s word. Our
approach encourages parents to be actively involved in the school’s program and to participate in their child’s
education. We believe education alone will not provide us with the wisdom we need to make right choices in a
rapidly changing world. We recognise that God is the source of all wisdom, and we are therefore committed to a
high standard of education that is based on the values that can weather the storms of life.
Andrew Evetts, Principal
Child’s Information
Given Names:
Legal Surname:
Date of Birth:
General procedures and information
Child’s CRN Number:
Residential Address:
(Please note: The ELC will disclose your residential address to Government Agencies for funding purposes)
Fee Schedule
Postal Address:
Start Date:
CLASS: Kindy/Pre Prep
Toddlers
Please tick box if this child is of Aboriginal or Torres Strait Islander decent: Yes
OR
No
Days/Hours Required
MONDAY from
Father/Guardian’s signature:
to
WEDNESDAY from
Mother/Guardian’s signature:
FRIDAY from
TUESDAY
to
from
to
THURSDAY from
to
to
Are you registered with Centrelink/Department of Human Services to receive the Child Care Rebate?
Wisdom and Discipline for Tomorrow’s Leaders
Date:
YES
NO
If so, who is the registered parent/guardian (this will be the person to whom the Centrelink correspondence is address to)
Name:
CRN Number:
Date of Birth:
Parent/Guardian Information
Persons authorised to collect the child other than parents
Full name of Mother/Guardian:
Name:
Residential Address:
Phone contact info: Home
Mailing Address:
Name:
Phone contact info: Home
Work
Email address:
Mobile
Phone contact info: Home
Employer:
Name:
Relationship to child:
Work
Mobile
Relationship to child:
Work
Mobile
Relationship to child:
Full name of Father/Guardian:
Phone contact info: Home
Work
Mobile
_____________________________________________________________________________________________________
Residential Address:
Publicity
Mailing Address:
I hereby give permission for my child to be included in media publicity/photos/television/website for the Burdekin Christian
College.
YES
NO
Phone contact info: Home
Work
Email address:
Who is the legal guardian of the child: mother
Mobile
Father/Guardian’s signature:
Employer:
Privacy
father
both
other
Note: if there is a Court Order (or any other legal issues) in place please provide this information to the Principal of the College
Who does the child live with: mother
father
grandparent
shared
if shared care please provide details
(eg one week with mum/dad or stays with father on weekends etc) ………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………………………………….
Emergency Contacts other than parents (to be used when attempts to contact parents is unsuccessful)
At least one emergency contact must be provided
Name:
Relationship to child:
Phone contact info: Home
Work
Name:
Mobile
Phone contact info: Home
Work
Mobile
_______________________________________________________________________________________________________
Child’s Development Profile
Has your child ever been diagnosed wth any of the following conditions, or shown any early indications?
Anxiety
Intellectual Impairment
Psychiatric Disorder
Learning difficulty (dyslexia)
Autistic Spectrum Disorder/Asperger’s
Physical Impairment
Speech Language Impairment
Social/Emotional Disorder (ADD, ADHD, OBH etc)
Are any of the abovementioned conditions likely to affect your child’s ability to participate in physical activities?
YES
At the Burdekin Christian College we value your privacy. In accordance with Queensland privacy laws the Burdekin Christian
College has a privacy policy which governs what information we collect from you, how we store it, and how we use such
information. The College collects personal and sensitive information to satisfy its legal obligations; to discharge its duty of
care; and to provide appropriate schooling for your child. Occasionally personal information such as academic achievements,
sporting achievements, student activities or other news is published in the College newsletter. This information may also be
included in the College magazine, or be placed onto the College website. The possibility may also arise when your contact
details are included in class lists and the College directory. If you do not agree with this you must advise us now. A full copy of
the Privacy Policy is available from the College office on request. Parents may seek access to any personal information
collected concerning their child and students may also seek access to personal information about themselves, however there
may be occasions when this access is denied. Such occasions would include where access would have an unreasonable impact
on the privacy of others; where students have provided information in confidence or where access may breach the College’s
duty of care to a student.
_______________________________________________________________________________________________________
Parent/Guardian Statement of Support
Relationship to child:
Hearing Impairment
Mother/Guardian’s signature:
As parent(s)/guardians of a student enrolled at Burdekin Christian College, I/we support the CARE values of the College by
agreeing to:
C
Reinforce by word and action the College’s foundation in the Lord Jesus Christ. I agree to respect the College’s
A
Christian beliefs and support its staged policies and procedures.
R
Encourage my child to apply him/herself to all aspects of College life to the best of their ability.
E
Present my child in correct uniform, and reinforce the College’s dress policy including the hair and jewellery policies. I
also agree to provide all necessary books and equipment as indicated by teaching staff, and will ensure fees are paid
on or before the due date except where special arrangements are made through the Principal.
Support the College if consequences are applied to my child for breaches of the CLEAR Standards of Conduct.
Respect all College staff and treat them with courtesy, politeness, honesty and kindness. I also agree to be held
responsible for any damage caused to property by my child while at the Burdekin Christian College and agree to
replace or repair damaged property.
I understand any demonstrated unwillingness to comply with this Statement of Support for the Burdekin Christian College may
lead to the withdrawal of my child’s enrolment.
NO
Father/Guardian’s signature:
Has your child ever been seen by any of the following specialists?
Psychiatrist
Psychologist
Specialist Clinic (Hospital/Private)
Physiotherapist
Optometrist
Speech Pathologist
Audiology Report
Other Specialist
Occupational Therapist
Paediatrician
Dietician
Please specify ………………………………
Mother/Guardian’s signature: