APPLICATION FORPLACEMENT IN A BENDIGO 7–10 GOVERNMENT SCHOOL, YEAR 7, 2014

  1. STUDENT INFORMATION
Family name: ______Given name: ______D.O.B: ______Gender:______
Residential address: ______Postcode: ______
Suburb/town: ______
Parent contact telephone number: Home: ______Work:______Mobile: ______
  1. BENDIGO 7–10 GOVERNMENT SCHOOLPREFERENCE (in order – complete all 4)
/ Office use only (date of distribution)
  1. ______

  1. ______

  1. ______

  1. ______

  1. MY CHILD WILL NOT BE ATTENDING A BENDIGO 7–10 GOVERNMENT SCHOOLIN 2014 Please tick if applicable
If you are certain that your child will not be enrolled in a Bendigo 7–10 secondary school you do not need to complete sections 2 and 4 of this form. Go to sections 5 and 6 and sign the form.
If you are in doubt, you should complete sections 2 (above), 4, 5 and 6 to ensure your child has a place in a state secondary school.
  1. OLDER BROTHERS/SISTERS
If you wish your child to attend the same school that an older brother or sister attends and who resides permanently at the same address please complete the following:
Name of older brother or sister: ______Year level in 2014:______
Name of school: ______
  1. PARENTS/GUARDIANS NAMES (please print in block letters)
Parent/guardian: Mr/Mrs/Miss/Ms: ______Surname: ______
Mr/Mrs/Miss/Ms: ______Surname: ______
6. SIGNATURES OF PARENTS/GUARDIANS
I certify that the above information is correct. If applicable,signatures of both parents/guardians are required.
Parent/guardian: ______Date: ______2013
______Date: ______2013

PRIVACY NOTICE

All information we collect about students and their parents/guardians will be kept confidential and only used for the purpose of placement. If you have any concerns about the privacy of the information please call the school principal of your child’s neighbourhood school.

CONSENT: I have read the Application for Enrolment,Year 7, 2014form and privacy notice and understand why this information is being collected and how it will be used. I agree to the disclosure of my child’s student information …………………………………………….……………….. (name)only for the purpose of enrolment at a secondary school.

Signature: ______Date: ______2013