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Student Enrolment Application Form (New family)
ID:0 | 22/11/2017 |
Recipient: Preview Recipient
Student Associated with this eForm: Preview Student
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* Mandatory fields | 
1
Child's Name

Child's Surname: *

Child's Given Name: *

Gender: *

Date of Birth: *
2
Child's Details

Child's Nationality: *

Child's Country of Birth: *

Entry Year Level (eg Year 7): *

Year of enrolment (eg 2018): *
3
Child's Address Details:

Child's Residential Address: *

Child's Postal Address (if different to Residential Address):
4
Child's Current School Details

Child's Current School/Preschool Name: *

School/Preschool Phone Number: *
5
Student Living Arrangements

Child resides with (Names of Parents/Guardians): *
6
Guardian 1 Details

Title: *

Given Name: *

Surname: *

Mobile Phone: *

Home Phone: *

Work Phone: *

Email Address: *

Occupation: *

Employer: *
7
Guardian 1 Residential Details:

Postal Address (If different to child):

Residential Address (if different to child):
8
Guardian 2 Details

Title: *

Given Name:

Surname:

Mobile Phone:

Home Phone:

Work Phone:

Email Address:

Occupation:

Employer:
9
Guardian 2 Residential Details

Postal Address (if different to child):

Residential Address (if different to child):
10
Sibling Details - Please list siblings in the family and their ages. If siblings attend Moama Anglican Grammar, give current year level and sports house.

Name:

Age:

Year level:

Sports House:

Name:

Age:

Year level:

Sports House:

Name:

Age:

Year level:

Sports House:
11
Child's Special Needs and Health Concerns

Does your child have any special needs which may impact on their education (eg. health, disability or learning/behavioural needs, including gifted)? *

Does your child receive support from any of the following professionals such as a tutor, psychologist, physiotherapist, occupational therapist, speech pathologist, integration aide etc (please provide details): *

Are there any medical or health issues relating to your child that could impact on his/her education (please provide details): *

Are there any special needs for your child that need to be addressed by the School: *
12
Enrolment Process (please read)

Payment of the Application Fee referred to below must accompany this application form (this fee is non-refundable).

Please forward a copy of your child's Birth Certificate to the School at your earliest convenience to info@moamagrammar.nsw.edu.au or by fax on 54801 313.

Enrolment interviews with the parent/s and child are usually conducted in the year prior to enrolment. If an offer of enrolment is made, acceptance is confirmed by completion of an Enrolment Acceptance and Data Collection form accompanied by an Enrolment Fee of $1,000 per child which is payable by the date specified in the Letter of Offer.

13
Parents/Guardians Declaration

We declare that the information in the Enrolment Application Form is true and correct and that any changes to these details will be provided to the School when and if they occur.

We understand that failure to disclose special needs may result in termination of our child's enrolment. *

14
Application Fee - Payment

(Please refer to the School's fee schedule on our Website)


Payment of Application Fee:

Application Fee to pay:

Total
15
General

Grand Total
16
Application Fee - Payment

(Please refer to the School's fee schedule on our Website)



Application Fee - Payment Total: 0
17
Administration Use Only

Application Received:

Received by:

Date Received:
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