APGS Booklet

APGS Student Information Submission

Student's Full Name *

Year Level *

STUDENT CONTACT DETAILS
Please fill in all details for the school’s records. If there is no information to be disclosed in any field please fill the field with “N/A” or put a line through the field, to confirm you have acknowledged the field but have no information to disclose. It is your responsibility to immediately inform the school in writing should any of the details given below change.

GIVEN NAMES as per passport/birth certificate *

D.O.B (DD/MM/YYYY): *

STUDENT EMAIL ADDRESS *

Student origin *

SURNAME as per passport/birth certificate *

FIRST LANGUAGE: *

MOBILE NUMBER: *

EMERGENCY CONTACT PEOPLE (first point of contact in an emergency - can include parents)

Contact 1 - Full Name *

Contact 1 - Mobile Phone *

Contact 1 - Relationship to student *

Contact 1 - Home Phone

Contact 1 - Email *

Contact 2 - Full Name *

Contact 2 - Mobile Phone *

Contact 2 - Relationship to student *

Contact 2 - Home Phone

Contact 2 - Email *

Contact 3 - Full Name

Contact 3 - Mobile Phone

Contact 3 - Relationship to student

Contact 3 - Home Phone

Contact 3 - Email

PARENT / GUARDIAN CONTACT DETAILS & LIVING ARRANGEMENTS

Parent / Guardian 1 Contact Name *

Parent / Guardian 1 - Residential Address *

Parent / Guardian 1 - Mobile *

Parent / Guardian 1 - Work Phone *

Parent / Guardian 1 - Relationship to Student *

Parent / Guardian 1 - D.O.B (DD/MM/YYYY) *

Parent / Guardian 1 - Home Phone

Parent / Guardian 1 - Email *

Parent / Guardian 2 Contact Name *

Parent / Guardian 2 - Residential Address *

Parent / Guardian 2 - Mobile *

Parent / Guardian 2 - Work Phone *

Parent / Guardian 2 - Relationship to Student *

Parent / Guardian 2 - D.O.B (DD/MM/YYYY) *

Parent / Guardian 2 - Home Phone

Parent / Guardian 2 - Email *

Family Status: *

Please Specify any specific details of living arrangements if required:

ADDRESS – SCHOOL TERM MAIN RESIDENTIAL ADDRESS

Street No & Name *

State *

Mobile *

Suburb *

Postcode *

Home phone

POSTAL ADDRESS: Same as Main Residential Address #1 *
Yes
No

Street No.& Name

State

Suburb

Postcode

Citizenship And Residency
CITIZENSHIP AND RESIDENCY

What is your citizenship status? *

Were you born in Australia? *

In what year did you arrive in Australia?

Are you of Aboriginal or Torres Strait Island origin? *

If No, what is your country of birth?

What is your Nationality? *

MEDICAL INFORMATION
MEDICAL INFORMATION
DOCTOR CONTACT DETAILS

Doctor’s Name *

Street No.& Name *

State *

Mobile *

Medicare No. *

Contribution No.

Suburb *

Postcode *

Phone *

Medical/Hospital Insurance Fund

PERMISSION FOR PANADOL TO BE ADMINISTERED

Do you agree to give permission for your child/ward to be administered with Panadol (as per the standard dosage) by an APGS staff member should the occasion arise? *
Yes
No

PERMISSION FOR EMERGENCY MEDICINES TO BE ADMINISTERED WHILE AT SCHOOL
It is your responsibility to deliver to the front office any emergency medicines your child requires. Place the emergency medicine into a clear plastic zipper bag. Clearly mark the bag with your child’s name, DOB, type of medicine, expiry date of medicine, any special handling instructions, dosage of medicine required & symptoms/conditions which would be present when required to take the medicine.

Medicine 1

Details of instances when & how medicine 1 should be administered. (PLEASE INCLUDE ANY ALLERGIES & THEIR SYMPTOMS)

Medicine 2

Details of instances when & how medicine 2 should be administered. (PLEASE INCLUDE ANY ALLERGIES & THEIR SYMPTOMS)

Please upload a WORD/PDF with any additional information required including ANAPHYLAXIS ACTION PLAN
Select files...

Do you agree to give permission for your child/ward to be administered with the medication listed above (as per the dosage instructions) by an APGS staff member should the occasional need arise? *
Yes
No
N/A

LEARNING DIFFICULTIES / MENTAL HEALTH / WELLBEING

Does your child require support for any Learning Difficulties or for their Mental Wellbeing? *
Yes
No

Details of Learning Difficulty / Mental Health / Wellbeing Support Required

Please upload a WORD/PDF file with extra information eg: Special Provisions Report, Counsellor's Letter, Psychologist Report etc
Select files...

PARENT BACKGROUND INFORMATION
PARENT BACKGROUND INFORMATION

Parent/Guardian 1: *

1. Highest level of school completed: *

2. Post school education *

3. Category of present occupation *

4. Main language other than English spoken at home: *

Parent/Guardian 2: *

1. Highest level of school completed *

2. Post school education *

3. Category of present occupation *

4. Main language other than English spoken at home *

PARENTAL PERMISSION FOR LOCAL EXCURSIONS

Your name *

I give permission for my child to be accompanied by a teacher during school hours to walk to learning venues in the local vicinity of APGS as part of the academic curriculum. I authorise and give permission for my child to leave APGS with his/her class and the teacher. *
Yes
No

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