Through Christ – learning, living, loving;
mind, body, soul

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1. Parents/Guardians

Parent/Guardian Email Address

Title

Given Names

Surname

Relationship to Student
FatherMotherGuardian/Other

Martial Status

Mobile

Home Phone

Residential Address

Suburb

State

Post Code

Country

Country of Birth

Nationality

Other language spoken (leave blank if none)

Religion

Occupation

Employer

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)

Parent/Guardian Email Address

Title

Given Names

Surname

Relationship to Student
FatherMotherGuardian/Other

Martial Status

Mobile

Home Phone

Residential Address

Suburb

State

Post Code

Country

Country of Birth

Nationality

Other language spoken (leave blank if none)

Religion

Occupation

Employer

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

2. Student Information

Surname

Christian Name(s)

Preferred Name

Gender
MaleFemale

Residential Address: (Must be a street address, not a PO Box)

City

Postal Code

Home Telephone Number

Is this a silent number?
YesNo

Postal Address

Date of Birth

Birthplace

Is this a student in State care?
YesNo

If yes, please specify: Period of State Care
From
To

Primary Email Address (for newsletter etc)

Australian Permanent Resident
YesNo

Please tick if your child is of
AboriginalTorres StraitPacific Islander descent

Nationality

Language spoken at home
EnglishOther

Religious Denomination

Home Congregation

Previous school (if applicable)

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

Are there any court parenting orders concerning residence, contact, child maintenance, education, health, or other specific issues relating to this student?
NoYes ( Please attach a copy of any orders)

If parents are separated or divorced, which parent has legal custody of student?
FatherMotherJointOther

4. Person Responsible for Payment of Accounts

Please Select
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

Name

Year Level

Age

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.

1. Has your child ever received Learning Support / Special Assistance?
YesNo

If yes, how many hours per day?

How many hours per week?

2. Has your child ever repeated a year?
YesNo

When?

3. Has your child ever been accelerated?
YesNo

When?

4. Does your child have a disability?
YesNo

If Other, specify:

Do you have a report from the above specialist/s?
(If yes, please attach copies of reports to the application)
YesNo

6. Does your child have any social difficulties?
YesNo

If yes, please specify

7. Has your child ever required behaviour support in the school setting?
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

Does your child have any allergies (including food allergies) or intolerances the School should be aware of, e.g. nut allergy?
YesNo

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

Does your child have any other medical conditions the School should be aware of? (e.g. Diabetes / previous operations)
YesNo

(If Yes), please provide details

Does your child take medication on a regular basis?
YesNo

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

Has your child been immunised?
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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About PEACE LPS

An independent co-educational school operating under the banner of Lutheran Education Australia. Peace has been serving the local community since it was established in 1982. The school was established by the Peace Lutheran Congregation to provide a quality Christian education to the children of its members.

Contact Info

36 East Street
Gatton QLD 4343
PH: 07 5462 0700
admin@peacelps.qld.edu.au

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