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All About Me – Prep Information Form
All About Me – Prep Information Form
Taryn Thomas
2022-06-23T15:35:30+10:00
ALL ABOUT ME
Prep Information Form
Step
1
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10
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MY INFORMATION (Prep Student)
Student Surname
(Required)
Surname (Legal Surname)
Student First and Middle Name
(Required)
First Name
I prefer to be called:
(Required)
MY FAMILY ORDER
My order in the family is number:
(Required)
1st
2nd
3rd
4th
5th
Order in the Family (Oldest to Youngest Siblings)
Child/Sibling Name
Age
Year of Birth
Add
Remove
EARLY CHILDHOOD EDUCATION
Where I attended Kindergarten, Family Day-care or Childcare
Name of Kindergarten
Length of time attended
Number of day per week attened
Add
Remove
COLLECTION PERMISSION
People I know who have permission to collect me from Prep
Name
Relationship to child
Mobile phone number
Home phone number
Add
Remove
Parental Permission for Collection
(Required)
I/We hereby elect to have the above-named person/s collect my child/ren from Prep when a parent is not available for collection.
Parent/Guardian Name
(Required)
Name and Surname
Relationship to student:
EMERGENCY CONTACT
This contact must be supplied to the College and updated when required. IMPORTANT If there are any changes to your address, phone numbers, emergency contact persons, email or other important information during your child’s enrolment at Genesis Christian College, you must change these details on Parent Lounge – the online portal of the College’s School Management System.
BEFORE AND AFTER SCHOOL CARE
This contact must be supplied to the College and updated when required. IMPORTANT If there are any changes to your address, phone numbers, emergency contact persons, email or other important information during your child’s enrolment at Genesis Christian College, you must change these details on Parent Lounge – the online portal of the College’s School Management System.
I will attend before and/or after school care on these days.
Day of the Week
Before School
After School
OSHC Centre of Family Day-Care Name
Phone number
Child arrives or collected by center bus in the morning?
Child arrives or collected by center bus in the afternoon?
Add
Remove
Does the student attend church, Sunday school or Christian youth/play group
Yes
No
Attendance
(Required)
Regular (weekly/fortnightly)
Occasional (monthly)
On special occasions (Christmas/Easter)
Religion / Faith
Church Denomination
Current Church
Christian Leader's Reference
There is no need to update your Christian Leader's Reference if you have previously provided one. However, if you are able to provide a reference at this time, please follow upload below.
I have previously provided a Christian Leader's Reference and there are no updates required
I have a Christian Leader's Reference to upload. (Please upload below)
Is this child from a non-Christian background or other religion?
Yes
No
If the family does not have a Christian faith background, what religious experience does this child have?
Upload Christian Leaders Reference here
Drop files here or
Select files
Max. file size: 10 MB.
Medical Needs
Does this student have any of the following medical needs? If yes to any medical needs, please provide detailed information (including reports from Specialist/s if available).
Vision
Yes
No
Allergies
Yes
No
Hearing
Yes
No
Serious illnesses, operations or accidents
Yes
No
Asthma/Respiratory Problems
Yes
No
Blood Disorder
Yes
No
Diabetes
Yes
No
Epilepsy
Yes
No
Heart Condition
Yes
No
Migraine
Yes
No
If 'Yes' selected above, please include detailed information here.
Upload files here
Drop files here or
Select files
Max. file size: 10 MB.
Specialist Services
Has this student attended or is scheduled to attend any of the following Specialist services? If yes to any specialist services, please provide detailed information (including reports from Specialist/s if available).
State/Child Guidance/Counsellor
Yes
No
Specialist Clinic (Hospital/Private)
Yes
No
Speech Pathologist
Yes
No
Audiologist
Yes
No
Occupational Therapist
Yes
No
Educational Psychologist/Consultant
Yes
No
Physiotherapist
Yes
No
Paediatrician
Yes
No
Psychiatrist/Psychologist
Yes
No
Other (e.g. Optometrist)
Yes
No
Other
If 'Yes' selected above, please include detailed information here.
Upload files here
Drop files here or
Select files
Max. file size: 10 MB.
Educational Needs / Disability / Impairment
Has your child ever been diagnosed/verified or suspected as having any of the following? If yes to any Educational Needs, please provide detailed information (including reports Specialist/s if available).
Autism/Asperger's
Yes
No
Vision Impairment
Yes
No
Hearing Impairment
Yes
No
Learning Difficulty/Disability
Yes
No
Intellectual Impairment
Yes
No
Dyslexia
Yes
No
Development Delay
Yes
No
Attention Deficit Disorder ADD
Yes
No
Physical Impairment
Yes
No
Attention Deficit Hyperactivity Disorder ADHD
Yes
No
Speech Language Impairment
Yes
No
Obsessive Compulsive Disorder OCD
Yes
No
Other
Yes
No
Other
If 'Yes' selected above, please include detailed information here.
Upload files here
Drop files here or
Select files
Max. file size: 10 MB.
Educational Adjustment Programs (EAP) / Ascertainment
Has the student been assessed as Gifted and Talented?
Yes, please specify in what subject/area below
No
Has the student repeated a year level?
Yes, please specify which year level below
No
Has the student been accelerated a year level?
Yes, please specify which year level below
No
Has the student received learning enrichment extension?
Yes, please specify which subject/s below
No
Has the student received learning enrichment support?
Yes, please specify which subject/s below
No
Has the student received an Educational Adjustment program?
Yes, please specify which category (e.g. HI; VI; PI; ASD;IU Level)
No
If 'Yes' selected above, please include detailed information here.
Please upload Educational Adjustment Program here
Drop files here or
Select files
Max. file size: 10 MB.
Psychological / Emotional / Pastoral Care Needs
Does the student have any social difficulties with other children?
Yes
No
Has the student been victimised or bullied in a previous educational setting?
Yes
No
Does the student require support in regards to specific emotional needs? e.g. loss of parent, trauma, social stresses, family breakdown?
Yes
No
Are any of the listed conditions above likely to affect the student’s ability to participate fully in school activities? (e.g. classroom learning, socialisation, sport, camps, excursions etc.)
Yes
No
Unsure
Does the student suffer from any psychological conditions? e.g. OCD, Phobias, Depression, Anxiety
Yes
No
If 'Yes' selected above please include detailed information here
Outstanding Documents
Please upload requested outstanding documents here e.g. Naplan; School Reports etc.
Drop files here or
Select files
Max. file size: 10 MB.
Disclosure and Release of Information
Please note the following conditions of enrolment at Genesis Christian College as specified in the Student Enrolment Contract; full and frank disclosure of all information must be provided by the parent/s, in writing, to the College regarding the student's medical, educational, physical,
emotional, or psychological conditions, during the enrolment process, leading up to the commencement of enrolment, and ongoing throughout the student’s enrolment at the College. Failure to provide full and frank disclosure in writing may be in breach of the subsequent contractual agreement thus rendering it void and the enrolment offer or ensuing enrolment, may be withdrawn.
Privacy Information: Genesis Christian College collects information about students to enable the College to provide appropriate education and support for each student and to discharge duty of care. Permission for release of information is obtained upon application for enrolment for this purpose. A request may be made by the College on behalf of parents to obtain school records or make contact with teachers and other professionals to assist in the education and support of students.
Parent/Guardian Name
Name and Surname
Relationship to student:
Date
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