Intention to Enrol Student's DetailsName* First Last Date of Birth* DD slash MM slash YYYY Home Address* Street Address Address Line 2 City Suburb ZIP / Postal Code Postal Address Same as Home Address Street Address Address Line 2 City Suburb ZIP / Postal Code Parent's/Caregiver's Details1. Parent's/Caregiver's1. Parent's/Caregiver's Name* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last 1. Parent's/Caregiver's Home Address* Same as Student Address Street Address Address Line 2 City Suburb ZIP / Postal Code 1. Parent's/Caregiver's Home Number*1. Parent's/Caregiver's Mobile Number*1. Parent's/Caregiver's Work Number1. Parent's/Caregiver's Email* 2. Parent's/Caregiver's2. Parent's/Caregiver's Name* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last 2. Parent's/Caregiver's Home Address* Same as Student Address Street Address Address Line 2 City Suburb ZIP / Postal Code 2. Parent's/Caregiver's Home Number*2. Parent's/Caregiver's Mobile Number*2. Parent's/Caregiver's Work Number2. Parent's/Caregiver's Email* Emergency ContactNot Parent/Caregiver1. Emergency Contact1. Emergency Contact's Name* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last 1. Emergency Contact's Relationship to child* 1. Emergency Contact's Home Number*1. Emergency Contact's Mobile Number*1. Emergency Contact's Work Number2. Emergency Contact2. Emergency Contact's Name Mr.Mrs.MissMs.Dr.Prof. Prefix First Last 2. Emergency Contact's Relationship to child* 2. Emergency Contact's Home Number*2. Emergency Contact's Mobile Number*2. Emergency Contact's Work NumberHealth Concerns (Allergies, Medication)Condition CommentsAgreementConsent* Information given on this form is true and correct. I understand that the information provided may be used for school and Board of Trustees activities. I have the right to see and correct my child's school records.Please write your name as form of digital signature* First Last Date* DD slash MM slash YYYY Other information (if relevant e.g. custody, sensitive, etc)