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



YesNo

From
To

YesNo

AboriginalTorres StraitPacific Islander descent


EnglishOther



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


Names of other students from this family currently enroled or enroling 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 enroling 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 enroled 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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