ESHS Enrolment

Student Details

What year will the student commence schooling at ESHS: *

Student's Surname *

Student's Legal Surname

Middle Names

Given Name *

Preferred Name

Student's Date of Birth *

Gender *

MaleFemaleNot Specified

Pronouns

Address (student's primary place of residence) *

Street address *City/Town

Suburb *

State *

Postcode *

Is the student of Aboriginal or Torres Strait Islander descent? *

NoYes, AboriginalYes, Torres Strait Islander (TSI)Yes, both Aboriginal and TSI

Current enrolled year *

Current or previously enrolled school *

Does the student speak a language other than English at home? *

English onlyOther - please specify

What is the other language spoken at home? *

Student's Religion

Are you planning on enrolling this student at Esperance Residential College? *

YesNo

Please note this enrolment is for Esperance Senior High School only.

Completing this enrolment does not guarantee a place at Esperance Residential College (ERC); for the student to stay at ERC you must also complete their seperate application process available here: Apply to ERC

Has this student previously attended ESHS? *

YesNo

Are there currently any siblings attending ESHS? *

YesNo

Please list any siblings names in full: *

Confidential Information

Does the family or student have a Health Care Card? *

YesNo

Please provide the health care card number: *

Health Care Card Expiry Date *

Are there any Family Court Orders regarding the day to day or long term care, welfare and development of the child? If yes, attach supporting documentation. *

YesNo

Upload Family Court Orders *

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Is the child subject to access restriction? If yes, attach supporting documentation. *

YesNo

Upload Access Restrictions *

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Is this student in the care of the Director General of the Department of Communities - Child Protection and Family Support (CPFS)? *

YesNo

Please specify the CPFS Case Manager.

Specify the CPFS District.

Specify the CPFS Contact Number.

Does the student receive any of the following allowances? (Check the boxes that apply)

Secondary AssistanceYouth AllowanceAssistance for Isolated Children (AIC)Abstudy

Student Digital Release

The Department of Education and Esperance Senior High School (ESHS) may record sound and/or vision of a student and their work while they are at the school, for taking part in school related activities or performances. Photographs of students and their work are often published to enable the students to share their experiences and inform parents and the community about the school’s programs and events. This does not mean that the student loses ownership of their work.

Student Digital Release Consent *

AcceptOpt Out

I give permission for ESHS to use images of my child in publications and digital formats to promote ESHS and the Department Of Education.

Residency Information

Country of birth *

Nationality

Is the Student an Australian citizen? *

YesNo

Is the student a permanent resident of Australia? *

YesNo

Please provide the Student's Visa Subclass Number: *

Is the student a tempory resident of Australia? *

YesNo

What was the Date of Arrival in Australia? *

What is the Visa Sub Class Number? *

When is the Visa Expiry Date?

Instrumental Music Elective

Does your child want to study class music? *

YesNo

Was your child involved in a primary school instrumental music program? *

YesNo

Diagnosed Learning Difficulty, Health Conditions, and Disability

This information will assist the ESHS with considering whether any specific or additional resources, services and/or supplementary funding are required and available to provide the best educational program for your child. Supporting documentation of diagnosis should be uploaded when you submit this application.

Does the student have a diagnosed learning difference? *

YesNo

Please upload reports or information relating to diagnosed learning difference if available.

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Does the student have a medical condition or intensive health care need? *

YesNo

Please select the medical condition *

Please upload the reports or information related to the medical condition.

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Parent/Carer Details

Parent/Carer 1 Details

This person will be listed as the first contact for the student in an emergency.

Title *

First Name *

Surname *

Gender *

MaleFemaleNot Specified

Relation to Student *

Address *

Street address *City/Town

Suburb *

State *

Postcode *

Mobile Number *

Telephone (Work)

Email *This email address will be used to create a DOE Parent/Carer Connect account to keep you up-to-date.

Parent/Carer 1 Responsibility

Responsible for parenting

Lives with student

Receive school Notifications/Connect/SMS *

YesNo

Responsible for payment of Contributions & Charges *

YesNo

Does Parent/Carer 1 speak a language other than English at home? *

English onlyOther - please specify

Please specify the other lanugage *

What is the highest year of school Parent/Carer 1 has completed?

Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalent or below

Completed

Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalent or below

What is the level of the highest qualification Parent/Carer 1 has completed?

Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I to IV (including trade certificate)No non-school qualification

Completed

Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I to IV (including trade certificate)No non-school qualification

What is the occupation group for Parent/Carer 1?

Parent/Carer 2 Details

This person is a trusted adult who will be listed as the second contact for the student in an emergency.

Title *

First Name *

Surname *

Gender *

MaleFemaleNot Specified

Relation to Student *

Address *

Street address *City/Town

Suburb *

State *

Postcode *

Mobile Number *

Telephone (Work)

Email *This email address will be used to create a DOE Parent/Carer Connect account to keep you up-to-date.

Parent/Carer 2 Responsibility

Responsible for parenting

Lives with student

Receive school Notifications/Connect/SMS *

YesNo

Responsible for payment of Contributions & Charges *

Yes

Does Parent/Carer 2 speak a language other than English at home? *

English onlyOther - please specify

Please specify the other lanugage *

What is the highest year of school Parent/Carer 2 has completed?

Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalent or below

Completed

Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalent or below

What is the level of the highest qualification Parent/Carer 2 has completed?

Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I to IV (including trade certificate)No non-school qualification

Completed

Bachelor degree or aboveAdvanced diploma/DiplomaCertificate I to IV (including trade certificate)No non-school qualification

What is the occupation group for Parent/Carer 2?

Do you want to add additional Parents/Carers? *

YesNo

Additional Parents/Carers are people who many not live with the student but are trusted individuals like Grandparents who may be contacted in an emergency when Parent/Carer 1 or 2 aren't able to be contacted.

Parent/Carer 3 Details

Title *

First Name *

Surname *

Gender *

MaleFemaleNot Specified

Relation to Student *

Address *

Street address *City/Town

Suburb *

State *

Postcode *

Mobile Number *

Telephone (Work)

Parent/Carer 4 Details (optional)

Title

First Name

Surname

Gender *

MaleFemaleNot Specified

Relation to Student *

Address *

Street address *City/Town *

Suburb *

State *

Postcode *

Mobile Number *

Telephone (Work)

Documents to Provide

Student Proof of Identity

If not provided at the time of enrolment, a copy of the Student's Birth Certificate will be required at a later date.

What type of proof of Student Identity *

Upload student proof of identity *

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Australian Immunisation Register (AIR) History Statement

If not provided at the time of enrolment, an up-to-date copy of the Student's Australian Immunisation Register History will be required at a later date.

Australia Immunisation Register History Statements are available on myGov. Log into myGov.

Upload AIR Statement

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Latest School Report

Upload latest school report

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Latest NAPLAN Report

Upload latest NAPLAN report

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Family Court Orders (if applicable)

Upload family court orders (if applicable)

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Information relating to diagnosed learning difficulty, health condition or disability (if applicable)

Upload Information relating to diagnosed learning difficulty, health condition or disability (if applicable)

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Declaration

By completing and submitting this Application for Enrolment, the parent or responsible person accepts responsibility for all information being considered to be true, complete and accurate. The person submitting this application also accepts responsibility for updating the school of any changes relating to the information provided. Incomplete enrolment forms will require additional contact to confirm the accuracy of the information if the following is satisfied:

the enrolment was obtained by the applicant giving false or misleading information
Esperance Senior High School has not been advised of changes to the following: the child’s usual place of residence; Court Orders or provisions pertaining to responsibility for the child’s long-term or day-to-day care; or details of any conditions that may call for special steps to be taken for the benefit or protection of the child or other persons at the school.

By ticking this box I declare the information and statements provided in this application for enrolment are true, complete and accurate in relation to: *

I the responsible parent/carer & the student have read and understand all ESHS policies. *

Name of Child

Student Name *

Name of person enrolling child

Parent/Carer Name *

Parent/Carer Surname *

Relation to Student *

Today's Date *

Signature *

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