Application Form Application Form Step 1 of 4 25% Parent Details – Mother / Guardian 1Full Name (Including Title)* Prefix Dr.MissMr.Mrs.Ms.Prof.Rev. First Middle Last Nationality* Work Phone Number*Mobile Phone Number*Home Address* Street Address Address Line 2 City ZIP / Postal Code Preferred Email for College communication* Employer* Occupation* Religion* Church name/denomination* Emergency Contact 1If Mother / Guardian 1 is uncontactable in an emergency (other than Father / Guardian 2).Name* First Last Relationship* Phone Number 1*Phone Number 2*Australian GovernmentThe Australian Government requires the following information about Mother / Guardian 1Name* First Last Country of Birth* Language spoken at home*(Other than English) What is the highest year of primary or secondary school you have completed?*(Please choose the most applicable option)Year 9 or equivalent or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalentWhat is the level of highest qualification you have completed?*(Please choose the most applicable option)Bachelor degree or aboveAdvanced Diploma/DiplomaCertificate I to IV (incl. Trade certificate)No school qualificationWhat is your Occupation Group?*Please refer to list of parental Occupation Groups included with application information and choose the most applicable below. GP 1 – Senior management and qualified professionals. GP 2 – Business manager, art/media/sport, associated professional GP 3 – Tradesmen/women, clerks, skilled office, sales service. GP 4 – Machine operators, hospitality, assistants, labourer, etc. Not Currently In Paid Work Not currently in paid work * If not currently in paid work, but have had job in last 12 months, please use last occupation. Parent Details – Father / Guardian 2Full Name (Including Title)* Prefix Dr.MissMr.Mrs.Ms.Prof.Rev. First Middle Last Nationality* Work Phone Number*Mobile Phone Number*Home Address* Street Address Address Line 2 City ZIP / Postal Code Preferred Email for College communication* Employer* Occupation* Religion* Church name/denomination* Emergency Contact 2If Father / Guardian 2 is uncontactable in an emergency (other than Mother / Guardian 1).Name* First Last Relationship* Phone Number 1*Phone Number 2*Australian GovernmentThe Australian Government requires the following information about Father / Guardian 2Country of Birth* Language spoken at home*(Other than English) What is the highest year of primary or secondary school you have completed?*(Please choose the most applicable option)Year 9 or equivalent or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalentWhat is the level of highest qualification you have completed?*(Please choose the most applicable option)Bachelor degree or aboveAdvanced Diploma/DiplomaCertificate I to IV (incl. Trade certificate)No school qualificationWhat is your Occupation Group?*Please refer to list of parental Occupation Groups included with application information and choose the most applicable below. GP 1 – Senior management and qualified professionals. GP 2 – Business manager, art/media/sport, associated professional GP 3 – Tradesmen/women, clerks, skilled office, sales service. GP 4 – Machine operators, hospitality, assistants, labourer, etc. Not Currently In Paid Work Not currently in paid work * If not currently in paid work, but have had job in last 12 months, please use last occupation. Child / Student DetailsName of child (as on Birth Certificate)* First Middle Last Country of birth* Place of birth* Date of birth* Day Month Year Male or Female* Preferred Name* Application for grade* Proposed date of entry* DD slash MM slash YYYY Residency Status*CitizenPermanent ResidentTemporary ResidentVisa Class* Arrival Date* Day Month Year Do you give permission for the College to use VEVO (Visa Entitlement Verification Online) to check Visa entitlements during period of enrolment?*YesNoNationality* Language(s) spoken at home* Is the student Aboriginal or Torres Strait Islander origin?*YesNoChild resides (lives) with* Both Parents Mother Father Guardian Other Are there any Family Court Orders in place in relation to this child?*YesNoIs this the child's first school?*YesNoCurrent school (if applicable)* Has the child had any behavioural issues at their previous school?*YesNoHas the child ever been suspended or expelled from another school?*YesNoIf Yes, please provide details*Has the child ever been diagnosed with a learning issue?*YesNoDoes the child have an impairment that may affect their learning?*YesNoHas the child ever been involved in a remedial education program?*YesNoHas the child ever been involved in a gifted and talented program?*YesNo Medical DetailsDoes the child have any health conditions that may affect his/her learning, participation or welfare during school hours?*YesNoIf Yes, please outline here*Has the child ever had an Individual Health Action Plan to help manage a health issue? (e.g. asthma, allergy/anaphylaxis)*YesNoIf Yes, please outline here*Does the child need to take any prescribed medications at school?*YesNoIf Yes, please outline here*Does the child toilet independently?(If within 6 months of commencing Kindergarten) – SKIP if NAYesNoDoctor’s (GP) name* Practice name* Practice phone number*Medicare Number* Student Medicare Position Number* Private Health Insurance details* Medical Emergency AuthorisationConsent*I/we authorise Regent College to send, at our cost, our child to hospital or a medical centre if urgent medical treatment is considered necessary, including transport by ambulance. I (Parent / Guardian 1) agree to the Emergency Medical Authorisation policy.Parent 2 Consent Field I (Parent / Guardian 2) agree to the Emergency Medical Authorisation policy.OtherOther Documentation*Please ensure you include copies of the following forms to the College Administration team Birth Certificate or Birth Extract Most recent school report (if applicable) Immunisation History Statement (from AIR) Specialist education/medical records (if applicable) Visa and passport documentation (if applicable) Citizenship Certificate (if applicable) Copies of Restraining Orders, Parent Responsibility Orders, Contact Orders, Parenting Plans or Court Orders CAPTCHA