Rotary Residential College

Application for Enrolment

All sections must be fully completed and the following documents (if applicable) included:

$150 Application Fee
Last 2 Semester school reports
Letter of Reference from their current Teacher or Principal
Copy of your child’s Birth Certificate, Medicare and Australian Immunisation Register History Statement, and any relevant medical documents.

STUDENT'S DETAILS

Student’s Full Name *

Gender *

Address *

Street address *

City *

State *

Postcode *

Students Email

Students Date of Birth *

Students Mobile *

Application for the year: *

Students Current School *

What High School will your child be attending? *

Has your child been accepted into this school? *

YesNo

Will your child be enrolment in an Approved Specialised Program? *

YesNo

If Yes, which Approved Specialised Program?

Does your child identify as an Indigenous or Torres Straight Islander? *

YesNo

Is your child eligible for Abstudy? *

YesNo

Is your child eligible for AIC (Assistance for Isolated Childen)? *

YesNo

LEGAL CUSTODIAN[S] OF THE STUDENT

Name *

Relationship to student *

Address *

Street address *

City *

State *

Postcode *

Mobile *

Parents / Guardians Email Address *

Name

Relationship to student

Address

Street address

City

State

Postcode

Mobile

Parents / Guardian Email Address

Who does the student reside with? *

EMERGENCY CONTACTS IN PERTH

Name *

Mobile *

Relationship to student *

Address *

Street address *

City *

State *

Postcode *

Name

Mobile

Relationship to student

Address

Street address

City

State

Postcode

Emergency contacts may be contacted by the college should the need arise or if parents can not be contacted, unless specifically advised otherwise.

STUDENT HEALTH INFORMATION

Please provide your child’s health information to help the college meet your child’s health needs. It is important that you maintain communication with the college, and advise of any changes or concerns you may have.

My child is fully Immunised? *

YesNo

Please attach latest dated Immunisation Statement *

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Does your child suffer from any the below conditions?

If "YES" to any options, please clarify

Is your child currently taking any medication? *

YesNo

If "YES" please provided details including dosage and frequency

Does your child suffer from any form of Mental Health issues including Depression, Anxiety, or any history of self-harm or suicidal ideation?

Mental Health Issues *

YesNo

Depression *

YesNo

Anxiety *

YesNo

Any history of self-harm or suicide ideation *

YesNo

If 'YES" to any option, please clarify.

Does your child have any specials needs, learning disabilities or behavioural issues? *

YesNo

If "YES" please clarify

Please provide your child's Medicare details below:

Medicare Number *

Exp: *

Number listed on card: *

Please upload a photo of Medicare Card *

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Does your child have any of the below cover:

Private Health Fund *

YesNo

Ambulance Cover *

YesNo

Health Care Card *

YesNo

Concession Card *

YesNo

If "YES" please provide details

Do you give permission for the college to call an ambulance in the case of an emergency *

YesNo

Do you give permission for staff to give any medical attention if felt appropriate *

YesNo

Do you give the college permission to take your child to medical appointments (understanding a $85 fee applies to students over the age of 16) *

YesNo

If "NO" please provide feedback

TERMS AND CONDITIONS

Terms and Conditions:

1.A non-refundable Application Fee of $150 per student must accompany this Application.

2. Lodgement of this Application does not guarantee a placeat the College.

3. I/we have completed this application form 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/enrolment process, especially in relation to this student’s individual needs, medical conditions, healthcare requirements and/or Court Orders, then the enrolment process may be refused or terminated on this ground.

4. Parents must supply their child’s latest and dated Australian Immunisation Register (AIR) History Statement upon enrolment. If your child has a valid reason why they cannot be vaccinated a GP needs to complete, sign and submit an AIR Immunisation Medical Exemption Form or provide notification directly the child’s online AIR record.

5. I/we will provide a copy of the student’s most recent school reports.

6. I/we will advise the College of any change of personal details including email details between the time of application and the duration of the enrolment.

7. A formal offer of placement at the College is made following a successful enrolment application by management.

8. I/we agree to abide by and support the college policies and procedures and lend full support to the staff of the college in the implementation of these policies and procedures

9. I/we accept full responsibility for the college fees and any other cost involved for the duration of enrolment of this student at the College.

10. I/we understand that the Annual Fee set out in the Fees and Charges Schedule is payable in accordance with the published payment options of the current year. A student may not be permitted to enter the college at the beginning of any Term unless all fees and charges are paid up to date.

11. I/we understand that a term’s notice must be provided to the college in writing, otherwise, the college is entitled to charge a term’s fee in lieu of notice given.

12. The college, at its discretion, may seek to recover from you any damage to the college’s property caused or contributed to by the student.

13. I/we agree that the student is solely responsible for loss or damage to personal property brought to the college.

I/We agree to the terms and conditions and give permission to process this Application for Enrollment. I/we understand that by signing this application I/we am agreeing to and will abide by the above terms and conditions for the full term of this child’s enrolment at Rotary Residential College. *

YesNo

Parent / Guardian Signature *

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Parent / Guardian signature

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Date *

Date

PAYMENT DETAILS

Non Refundable $150 Application Fee

Please Note: An application will not be considered and processed until the Application Fee has been paid.

Please use the below direct debt information to make this payment.

Direct Deposit Details

Account: Rotary Residential College

Bank: Bendigo Bank

BSB: 633-000 Account No. 125130666

Payment Reference: Student Name

Successful applications are based on boarding room vacancies, payment of fees, successful enrolment at a suitable high school, and the student’s character reference[s].

STUDENT'S DETAILS

LEGAL CUSTODIAN[S] OF THE STUDENT

EMERGENCY CONTACTS IN PERTH

STUDENT HEALTH INFORMATION

OTHER DOCUMENTATION REQUIRED

TERMS AND CONDITIONS

PAYMENT DETAILS