Enrolment Form

Administration Office:

36 East Street Gatton QLD 4343

admin@peacelps.qld.edu.au

Phone: 07 5462 0700

Submission of this form is the first step in enrolment. All enrolment applications are subject to an interview before a place may be offered. Please ensure you notify the school of any change of address.

    1. Parents/Guardians

    Title

    Relationship to Student
    FatherMotherGuardian/Other

    Martial Status

    Mobile

    Home Phone

    Residential Address

    Suburb

    State

    Post Code

    Country

    Country of Birth

    Current or past employee at Peace Lutheran Primary School
    YesNo

    Past student of Peace Lutheran Primary School
    YesNo

    School Education
    Year 9 or equivalent or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalent

    Non-School Education
    Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I IV (including trade)No non-school qualification

    Occupation Group:
    Group 1 (Senior management in large business organisation, government administration and defence, and qualified professionals.)Group 2 (Other business managers, arts/media/sportspersons and associate professionals.)Group 3 (Tradesmen/women, clerks and skilled office, sales and service staff.)Group 4 (Machine operators, hospitability staff, assistants, labourers and related workers.)Group 8 (Not in paid work in last 12 months.)

    New Parent/Guardian Entry (optional)

    Title

    Relationship to Student
    FatherMotherGuardian/Other

    Martial Status

    Mobile

    Home Phone

    Residential Address

    Suburb

    State

    Post Code

    Country

    Country of Birth

    Current or past employee at Peace Lutheran Primary School
    YesNo

    Past student of Peace Lutheran Primary School
    YesNo

    School Education
    Year 9 or equivalent or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalent

    Non-School Education
    Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I IV (including trade)No non-school qualification

    Occupation Group:
    Group 1 (Senior management in large business organisation, government administration and defence, and qualified professionals.)Group 2 (Other business managers, arts/media/sportspersons and associate professionals.)Group 3 (Tradesmen/women, clerks and skilled office, sales and service staff.)Group 4 (Machine operators, hospitability staff, assistants, labourers and related workers.)Group 8 (Not in paid work in last 12 months.)

    2. Student Information

    Gender
    MaleFemale



    YesNo


    From
    To


    YesNo


    AboriginalTorres StraitPacific Islander descent



    EnglishOther




    PrepYr 1Yr 2Yr 3Yr 4Yr 5Yr 6



    Names of other students from this family currently enrolled or enrolling at this school in the future:

    1. Name Date of Birth

    2. Name Date of Birth

    3. Name Date of Birth

    4. Name Date of Birth

    3. Legal Custody


    NoYes ( Please attach a copy of any orders)


    FatherMotherJointOther


    FatherMotherJointLegal Guardians


    FatherMotherJointLegal Guardians

    4. Person Responsible for Payment of Accounts


    Joint responsibility for mother and fatherFather onlyMother onlyOther

    5. Media Permission Statement

    Consent to the publication of photographs and student work. This seeks your consent to the reproduction of:

  • Photographs taken during the student’s schooling.

  • Samples of student’s work where the student also consents

  • Student photographs and/or work samples in school publications, such as the school newsletter, facebook, website, brochures etc

    • I give consent to the school to publish photographs and student work in school publications

    YesNo

    6. General Excursion Permission Statement

    I/We give permission for my/our child to participate in excursions and off campus activities associated with their course of study that are held during class time.

    I understand and accept that:

  • Students will travel in a bus to any off campus activities (unless otherwise advised)

  • Appropriate supervision ratios will be in place and that teachers will exercise their duty of care

  • Students will be expected to follow the School’s code of behaviour

  • Students will wear the appropriate uniform (this will be the formal uniform with formal hat unless otherwise advised. Students will not be permitted to attend the activity unless in appropriate uniform.

    • YesNo

    Special Instructions

    Note: The school will advise you in writing of off-campus activities. For overnight activities, a separate permission form will be used.

    Please note: This consent for media and general excursions is valid for the duration of your child’s enrolment at Peace. You acknowledge that you understand and agree that if you wish to withdraw your consent, it will be your responsibility to inform the school in writing

    7. Student Needs Profile

    Please fill out this form even if it isn’t applicable to your child.

    8. Meeting your child's needs

    Our School offers a broad range of curricular and co-curricular activities. It is important to us that we, as a school, can meet the educational needs of each child. For this reason, all parents are required to complete the following form which will facilitate the enrolment process and enable us to determine the resources required to meet each individual student’s needs.


    YesNo

    If yes, how many hours per day?



    YesNo

    When?


    YesNo

    When?


    YesNo


    IntellectualSocial/EmotionalNon-verbal learning disordersPhysicalAutism Spectrum DisorderHearingVisionSpecific Learning DisorderADHDA.D.D.Speech LanguageOther

    If Other, specify:


    YesNo

    If yes, please specify:
    Guidance OfficerDevelopmental OptometristPaediatricianSpeech PathologistOccupational TherapistPsychologist/CounsellorOther

    If Other, specify:


    YesNo


    YesNo

    If yes, please specify


    YesNo

    If yes, please specify

    9. Medical Emergency Authorization

    I/we authorise the school to seek medical/dental attention, call an ambulance or to hospitalise my/our son/daughter when considered necessary. I/we further authorise the school that if an emergency occurs
    requiring surgery, anaesthetic, oxygen, blood transfusion, medication and I am unable to be contacted within a reasonable time, the school has the authority to agree to medically recommended treatment by an accredited
    medical practitioner on my behalf.

    Emergency Contacts: Who may we contact if a parent or guardian cannot be reached in an emergency?

    1. Contact Name

    Relationship to Student

    Phone No. 1

    Phone No. 2

    Address

    2. Contact Name

    Relationship to Student

    Phone No. 1

    Phone No. 2

    Address


    YesNo

    (If Yes), please specify (including the severity)


    YesNo

    (If Yes), please provide details


    YesNo

    If Yes, what type of medication does your child take and how often?


    FullyIncompleteNot Immunised

    Please note: You must provide evidence of vaccinations when first enrolling in Peace Lutheran School.

    10. Family Information

    Do you have a religious belief, cultural background or special circumstance that you would like the school to be
    aware of in order to support your child/children. (eg dietary needs)

    Please state your main reasons for wishing to enrol your child at Peace Lutheran School:

    11. Verification of Enrolment

    Parents wishing to apply for their child to be enrolled at Peace Lutheran Primary School are asked to:

    a) Complete and sign this application; and
    b) Include the enrolment application fee of $50; and
    c) Forward the application form and enrolment application fee to the school.

    Please note that the enrolment fee is an administration fee and is non-refundable.
    For Prep enrolments, you will be asked to confirm an enrolment interview time. For enrolment at other year
    levels you will be contacted for an enrolment interview. Waiting lists can occur and preference may be given
    to families who are Lutheran or have current siblings (as per constitution).
    Following a successful interview an Enrolment Contract will be posted and confirmation of your acceptance
    will be required accompanied by a Confirmation Fee of $150.00. This fee is charged per family
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