Enrolment Application Form

STUDENT DETAILS

Student Name *

Date of Birth *

Gender *

Student Language Group e.g. Bunuba, Walmajarri, Nyikina etc *

Language spoken at home e.g. Kriol, English etc *

Student Mobile Number

Current Year Level

The student lives with: *

Home address *

Is the student Aboriginal, Torres Strait Islander or both? *

Unique Student Identifier number (USI)

SCHOOLING DETAILS

Name of the current or most recent school *

When did the student last attend that school? *

What is the student's favourite thing about school?

What is the hardest thing about school?

What does the student love to do in their spare time?

Has the student ever been involved with the police or juvenile court system? If so, what happened? *

Why is the student interested in going to Yiramalay Studio School? *

PARENT/GUARDIAN 1

It is a government requirement that the following background information is collected.

Parent Name *

Gender *

Date of Birth *

Relation to the Student *

Occupation *

Language Spoken at Home *

Highest Level of Education *

Email

Mobile Number *

Home Address *

Postal Address (if different)

PARENT/GUARDIAN 2 (if applicable)

Parent Name

Gender

Date of Birth

Relation to the Student

Occupation

Language Spoken at Home

Highest Level of Education

Email

Mobile Number

Home Address

Postal Address (if different)

STUDENT MEDICAL DETAILS

Medicare Number

Reference Number

Expiry

Centrelink: Student Healthcare/Concession Card?

Yes No

Student CRN

Expiry Date

Family Doctor/Clinic

Private Health Insurance

YesNo

Private Health Insurance Number

Ambulance Cover

Yes No

Ambulance Cover Number

FURTHER MEDICAL DETAILS

Is the student on any medications? If yes, please list name and dosage *

YesNo

Medication details

Does your child have treatment, medicine or action plans for any of the illnesses above or any not listed? If yes, please provide details and relevant action plans *

YesNo

Treatment, medicine or action plans information

Smoking cigarettes *

NeverOccasionalFrequent

Substance use *

NeverOccasional Frequent

EMERGENCY CONTACTS

Emergency contacts need to be different from the parent/guardians listed above.

Emergency Contact 1 Name *

Relation to student *

Mobile Number *

Emergency Contact 2 Name

Relation

Mobile Number

Emergency Contact 3 Name

Relation

Mobile Number

PERMISSION

Please read each of the following five sections carefully and sign at the end to acknowledge your acceptance of the permissions requested.

1. Medications

Studio Schools of Australia may need to access medical records and information held by health services to provide care for your child. Please sign if you give permission for the school to access medical records and health information held by other organisations.

Over the counter medications will be made available and administered to students for the relief of minor allergies, minor pain, coughs and colds etc.

I give permission for administration of any 'over the counter' medications as needed for my child whilst in the care of Studio Schools of Australia.

AND

I give permission for administration of the listed prescription medication to be administered to my child whilst in the care of Studio Schools of Australia

AND

In the event of an emergency and I am unable to be contacted, I give consent for the Prinicpal to give informed consent for my child to undergo an operation, including administration of anaesthetics and blood transfusions as needed.

2. Release and Transfer of Medical Records and Health Information

Studio Schools of Australia may need to access medical records and information held by health services to provide care for your child. Please sign if you give permission for the school to access medical records and health information held by other organisations.

3. Student Image Release

Studio Schools of Australia uses images and video footage of individuals in websites (https://www.studioschools.edu.au/), social media channels (Facebook, Twitter, Instagram, YouTube), publications, advertising, marketing materials and public relations. Please sign if you give permission to use your child's image as stated above.

4. Transportation of Students in Vehicles

There may be instances when students are driven in school vehicles on local excursions and when they return home. Please sign to give your permission for your child to travel in school vehicles.

5. Unique Student Identifier (USI)

I give permission for Studio Schools of Australia to search for or create a USI for my child.

Please sign if you have read and accept the five permissions requested above.

Name *

Parent / Guardian Signature *

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Date *

TERMS AND CONDITIONS

Enrolment is subject to the following:

1. Smoking and the consumption of alcohol is not permitted for the duration of the student's enrolment at the school

2. Studio Schools of Australia does not encourage romantic relationships whilst students are in the program. Entering the sleeping accommodation of the opposite sex is not permitted.

3. The use of social media e.g. Facebook, Instagram etc. by the student while on the program should not be used to slander, ridicule or bully school staff or students.

4. The student's property is the responsibility of the student. Studio Schools of Australia accepts no responsibility for the loss or damage of student property and reserves the right to search rooms, phones, and other devices for inappropriate material.

5. If a student wilfully damages any Studio Schools of Australia property, the cost of repair and / or replacement will be aggregated and on-charged to the student's parent / guardian. Payment of any on-charges is expected within 30 days. If on-charges are not paid within 30 days, SSA reserves the right to commence recovery actions with any additional costs payable by the family / guardian.

I / We have read and accept the conditions of enrolment as set out above and assure that all information provided on this enrolment is truthful and correct.

Parent / Guardian 1 Signature *

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Parent / Guardian 2 Signature

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Date *