ENROLMENT APPLICATION

BALMORAL CAMPUS (YRS K – 6) DUNCAN CAMPUS (YRS 7 – 12) 66 BALMORAL ST 15 DUNCAN STREET

EAST VICTORIA PARK WA 6101 VICTORIA PARK WA 6100 P: +61 8 9470 0400 P: +61 8 9470 0900

E: enrolments@ufcc.wa.edu.au

W: www.ufcc.wa.edu.au

CRICOS Provider Code: 00765K | ABN: 99 024 601 686

OFFICE USE ONLY STUDENT NAME: ____________________________

FAMILY KEY: _______________________________

STUDENT KEY: _____________________________

ACADEMIC YEAR: ______ CALENDAR YEAR: ______

CRITERIA CODE: _______________ SIBLING: Y / N

RECEIPT No: __________ DATE PAID: __ / __ / __

PAYMENT MADE: $_____________

ACADEMIC YEAR FOR ENTRY: ________________ CALENDAR YEAR FOR ENTRY: ____________________

SURNAME: _________________________________ CHRISTIAN NAME: _______________________________

OTHER NAMES: _____________________________ PREFERRED NAME: _______________________________

DATE OF BIRTH: ___ / ___ / ___ GENDER: M / F

PLACE OF BIRTH: ____________________________ COUNTRY OF BIRTH: ______________________________

AUSTRALIAN PERMANENT RESIDENT: Y / N

IF BORN OUTSIDE AUSTRALIA:

COUNTRY OF CITIZENSHIP: ____________________ DATE OF ARRIVAL IN AUSTRALIA: ___ / ___ / ___

NUMBER OF YEARS IN AUSTRALIA: ______________ TYPE OF VISA: ___________________________________

VISA CLASS: ________________________________ VISA EXPIRY: ___ / ___ / ___

ABORIGINAL/TORRES STRAIT ISLANDER: Y / N

IF YES TO ABORIGINAL/TORRES STRAIT ISLANDER – GROUP OF ORIGIN: ________________________________

LANGUAGE SPOKEN AT HOME: __________________

IF CURRENTLY ENROLLED – PRESENT SCHOOL NAME: _______________________________________________

LOCATION: _________________________________ YEAR LEVEL: ________

HOW DID YOU HEAR ABOUT THE COLLEGE?: _______________________________________________________

TITLE: ______ SURNAME: _____________________ CHRISTIAN NAME: ________________________________

ADDRESS: __________________________________________________________________________________

SUBURB: ___________________________________ STATE: ___________ POSTCODE: __________________

TELEPHONE (H): _____________________________ TELEPHONE (W): _________________________________

MOBILE: ___________________________________ EMAIL: _________________________________________

RELIGION: _________________________________ PARISH: ________________________________________

OCCUPATION: ______________________________ EMPLOYER: _____________________________________

COUNTRY OF BIRTH: _________________________ COUNTRY OF CITIZENSHIP: ________________________

LANGUAGE/S SPOKEN AT HOME: ________________________________________________________________

ARE YOU A PAST STUDENT OF THE COLLEGE?: Y / N YEAR OF GRADUATION: ___________

TITLE: ______ SURNAME: _____________________ CHRISTIAN NAME: ________________________________

ADDRESS: __________________________________________________________________________________

SUBURB: ___________________________________ STATE: ___________ POSTCODE: __________________

TELEPHONE (H): _____________________________ TELEPHONE (W): _________________________________

MOBILE: ___________________________________ EMAIL: _________________________________________

RELIGION: _________________________________ PARISH: ________________________________________

OCCUPATION: ______________________________ EMPLOYER: _____________________________________

COUNTRY OF BIRTH: _________________________ COUNTRY OF CITIZENSHIP: ________________________

LANGUAGE/S SPOKEN AT HOME: ________________________________________________________________

ARE YOU A PAST STUDENT OF THE COLLEGE?: Y / N YEAR OF GRADUATION: ___________

STUDENT INFORMATION

MOTHER / FEMALE LEGAL GUARDIAN INFORMATION

FATHER / MALE LEGAL GUARDIAN INFORMATION

RELIGIOUS DENOMINATION: ___________________ PARISH PRIEST: _________________________________

PARISH: ____________________________________ SUBURB: _______________________________________

DATES OF RECEPTION OF SACRAMENTS:

BAPTISM: ___ / ___ / ___ RECONCILIATION: ___ / ___ / ___

EUCHARIST: ___ / ___ / ___ CONFIRMATION: ___ / ___ / ___

To assist us with providing the best possible education and care for your child, please supply as much information as possible.

MEDICARE No: ____________________ (REF) ____

MEDICAL/HEALTH CARE NEEDS: _____________________________________________________________

KNOWN ALLERGIES: _______________________________________________________________________

MEDICATION: ____________________________________________________________________________

If medication or medical/health care services are required during school hours please attach a letter to the application with full details, name and contact number and signed authorisation by a medical practitioner.

IMMUNISATION RECORD: Please complete the boxes using one of the corresponding letters as outlined below.

F = Fully immunised N = Not immunised I = Incomplete immunisation P = Personal objections

Measles Mumps Rubella Tetanus Diphtheria

Polio (OPV) Hepatitis B Pertussis (Whooping Cough)

FAMILY DOCTOR: ____________________________ PHONE: _____________________________________

MEDICAL CLINIC ADDRESS: _________________________________________________________________

MEDICAL EMERGENCY AUTHORISATION: I authorise the College to seek medical/dental attention, call an ambulance or hospitalise my son/daughter if considered necessary. I further authorise the College that if a medical emergency occurs requiring surgery, anaesthetic, oxygen, blood transfusion or medication and I am unable to be contacted within a reasonable time, the College has the authority to agree to medically recommended treatment by an accredited medical practitioner on my behalf. SIGNATURE OF PARENT/GUARDIAN: ___________________________________________________________

DATE: ___ / ___ / ___

Please provide emergency contact details for relatives/friends who are not the parent/guardian of the child.

(1) NAME: _________________________________ RELATION TO STUDENT: ___________________________

PHONE (H): ________________________________ PHONE (W): _____________________________________

MOBILE: __________________________________ EMAIL: _________________________________________

(2) NAME: _________________________________ RELATION TO STUDENT: ___________________________

PHONE (H): ________________________________ PHONE (W): _____________________________________

MOBILE: __________________________________ EMAIL: _________________________________________

RELIGIOUS INFORMATION

MEDICAL INFORMATION

EMERGENCY CONTACT INFORMATION

Please list all siblings (Note: a separate application form is required for each child)

SIBLINGS ATTENDING THE COLLEGE:

NAME: __________________ YEAR LEVEL: _______ NAME: __________________ YEAR LEVEL: _______

NAME: __________________ YEAR LEVEL: _______ NAME: __________________ YEAR LEVEL: _______

SIBLINGS ATTENDING ANOTHER SCHOOL:

NAME: __________________ YEAR LEVEL: _______ SCHOOL ATTENDING: _____________________________

NAME: __________________ YEAR LEVEL: _______ SCHOOL ATTENDING: _____________________________

NAME: __________________ YEAR LEVEL: _______ SCHOOL ATTENDING: _____________________________

STUDENT RESIDES WITH: Mother Father Both Legal Guardian

If there is a current custody or guardianship situation please complete the following (Note: Under the provisions of the Family Law Reform Act 1995, biological parents are regarded as having full parental responsibility unless a Parenting Plan or Court Order is presented stating otherwise).

NAME OF PERSON/S WITH LEGAL GUARDIANSHIP OF THE STUDENT: ___________________________________

ANY OTHER CONDITIONS ENFORCED AT LAW: _____________________________________________________

If applicable, a copy of any Parenting or Restraint Order must be provided.

To assist the College to respond to individual requirements, please details any special needs your child has in the following area(s) that may affect his/her learning, participation or welfare during school hours or at school functions.

KNOWN LEARNING DIFFICULTIES: _______________________________________________________________

SENSORY (VISION/HEARING): __________________________________________________________________

PSYCHOLOGICAL/COGNITIVE: __________________________________________________________________

ORTHOSES/PROSTHESES: _____________________________________________________________________

BEHAVIOURAL/SAFETY: _______________________________________________________________________

COMMUNICATION: ___________________________________________________________________________

Does your child receive any services from an external agency (e.g. Occupational Therapist / Speech Therapist / Psychologist): Y / N

If yes, please provide the Service Provider Name, Contact Number and details of service: ____________________

___________________________________________________________________________________________

Does your child require special transport arrangements to/from school?: Y / N

Does your child receive respite care on a regular basis?: Y / N

Would you like further information regarding the Education Support Centre at Duncan Campus?: Y / N

PRIVACY

The information collected on this form, its use and disclosure is governed by Privacy Laws. Please refer to the College’s Privacy Policy which can be viewed on the College website: www.ufcc.wa.edu.au

Do you agree that the information supplied in the Student Information and Family Information sections can be provided to the relevant Parish Priest?: Y / N

FAMILY INFORMATION

STUDENT INDIVIDUAL NEEDS

DISCLOSURE

It is essential both parents/guardians and students read and sign the following agreements prior to submitting this application for consideration. In order to uphold the traditions and reputation of the College and for the mutual benefit of all students, their families and members of the community, the expectations of students and their parent(s)/guardian(s) are set out below. PARENT(S)/GUARDIAN(S) UNDERTAKING:

As parent(s)/guardian(s) of a student attending Ursula Frayne Catholic College I/we jointly and severally:

1. Agree to abide by the College’s policies and other regulations which may be made from time to time. 2. Will endeavour to help in the various school support activities (e.g. canteen, camps, excursions, retreats and other official

school councils). 3. Agree to support College parking directions in relation to the collection or drop-off of students at the campus. 4. Agree to promptly pay tuition and other fees and charges as determined by the College Board (unless other arrangements

have been made on a confidential basis). 5. Agree that a full term’s notice in writing must be given to the Principal before the removal of a student from the College.

Failure to give such notice will involve payment of the fee for the term notice period, irrespective of the date the student leaves the College. Should the student be required to leave the College for any reason, the fee for the notice period will be charged.

6. Understand that if fees are not paid, the debt shall be transferred to a collection agency. I/we further understand that I/we will be responsible for all fees incurred in the collection of the fees payable to the collection agency.

7. Exonerate the College, its staff and agents from any legal responsibility for loss of personal effects, including money, belonging to the student.

8. Will ensure the student wears the full College uniform as prescribed and adheres to College uniform policy. 9. Agree that my child will participate fully in all activities arranged by the College, such as Frayne Day celebrations, sporting

carnivals, excursions and other school activities.

I/we undertake to accept the Principal’s ruling in relation to any breach of the Enrolment Agreement. SIGNATURE OF PARENT/GUARDIAN: ___________________________ __________ DATE: ___ / ___ / ___ FEMALE PARENT/GUARDIAN

SIGNATURE OF PARENT/GUARDIAN: ___________________________ __________ DATE: ___ / ___ / ___ MALE PARENT/GUARDIAN

STUDENT UNDERTAKING (not required if student is enrolling in Kindergarten to Year 2):

As a student attending Ursula Frayne Catholic College, I undertake to:

1. Do everything in my power to uphold the motto ‘Centred in Christ’. 2. Make an honest effort to achieve my personal best in all courses of study. 3. Act at all times with respect towards College staff. 4. Behave in public in such a way as to uphold the good name of the College. 5. Comply with all College policies and regulations as detailed in the Handbook. 6. Adopt a responsible, positive attitude while attending the College and when involved in College activities. 7. Wear the full College uniform as prescribed and adhere to College uniform policy. 8. Be punctual for all classes. 9. Participate fully in all activities arranged by the College, such as Frayne Day celebrations, sporting carnivals, excursions

and other school activities. 10. Make myself available upon request to represent the College in sporting and cultural activities, even when they take place

outside of normal school hours. 11. Refrain from the following forms of behaviour prejudicial to the achievement of the aims of the College:

• Disruption of lessons through inappropriate behaviour. • Unauthorised absence from class or school. • Undermining the religious and moral values promoted by the College.

12. Refrain from the following forms of morally/socially unacceptable behaviour at the College, at College functions or while travelling to/from school or College events:

• Possession or use of alcohol, tobacco or illicit drugs. • Vandalism or theft. • Intimidation or harassment of other people, either physically or verbally. • Offensive language or behaviour, or possession of offensive literature.

I am aware that the College policy with regard to the use or possession of illicit drugs or alcohol on school property or at school functions includes a penalty or forfeiture of the right to retain a place at the College.

I acknowledge that failure to fulfil these undertakings constitutes a breach of this Enrolment Agreement. Should this happen, I understand that the Principal may terminate my enrolment. SIGNATURE OF STUDENT: _____________________________________ DATE: ___ / ___ / ___

ENROLMENT AGREEMENT

I/we understand and accept that the completion of this application for enrolment form and acceptance by the College does not guarantee an enrolment interview. Successful applicants will be determined in accordance with the College’s enrolment criteria. I/we understand and accept that attendance at an interview does not guarantee an enrolment offer being made. I/we understand that enrolment in one Catholic school does not guarantee the enrolment of that student in any other Catholic school.

I/we have completed this enrolment application form fully and to the best of my/our knowledge. Further, I/we acknowledge and accept that if it can be demonstrated that I/we have withheld information relevant to the application process, especially in relation to this student’s medical conditions, healthcare requirements, Parenting Order/s or individual needs, then the enrolment may be refused or terminated on these grounds.

I/we have read and fully understand and agree that enrolment in a Catholic school means that I/we and our child will participate fully in the required aspects of the educational program of the school including the Religious Education program of the school.

I/we have read and fully understand and agree to the Terms and Conditions set out in the College Fee Collection Policy.

I/we agree to abide by the policies and directions of the College and the Catholic Education Commission of Western Australia as they are enacted from time to time. SIGNATURE OF PARENT/GUARDIAN: ___________________________ __________ DATE: ___ / ___ / ___ SIGNATURE OF PARENT/GUARDIAN: ___________________________ __________ DATE: ___ / ___ / ___

Please ensure that all required documentation has been provided with your Enrolment Application. Failure to do so will delay or halt the application process.

Copy of Birth Certificate Copy of any relevant Health Plans / Specialist Reports

Copy of Passport / Visa Copy of any Educational Adjustment Plan

Copy of AIR Immunisation History Statement Copy of most recent School Semester Report

Parish Priest Reference Copy of most recent NAPLAN Report

Copy of Sacramental Certificates Copy of any relevant Custodial Court Orders

Please consult the website (www.ufcc.wa.edu.au) for information regarding the Application Fee amount, annual College Fees and other amounts payable. The Application Fee is payable for each student application and can be made using one of the following options: Cheque / Money Order (made payable to Ursula Frayne Catholic College)

Bank Transfer

REFERENCE: Student surname, first initial, academic year/calendar year.

BANK: NAB

BSB: 086-006

ACCOUNT: 5450 59969

Credit Card: Visa / Mastercard / Amex

Name on card: _____________________________ Expiry Date: ___ / ___

Payment Amount: $ ___________ CVV: ________

Signature: ________________________________ Date: ___ / ___ / ___

ACKNOWLEDGEMENT

DOCUMENTATION CHECKLIST

ENROLMENT APPLICATION FEE PAYMENT