CONCESSION /HEALTH CARE PREFERRED CARD HOLDER? METHOD OF CONTACT? PARENT 2 PARENT 2 NAME PARENT 2 SURNAME PARENT 2 DATE OR PARENT 2 CRN: PARENT 2 EMAIL ADDRESS: PARENT 2 GENDER: FORMER NAMES PARENT HAS BEEN KNOWN BY ADDRESS: SUBURB: POSTCODE: PLACE OF BIRTH HOME PHONE WORK NUMBER MOBILE NUMBER LANGUAGE SPOKEN AT HOME OCCUPATION PLACE OF WORK: WORK STARTS: WORK FINISHES CONCESSION /HEALTH CARE PREFERRED CARD HOLDER? METHOD OF CONTACT? FAMILY STATUS (Please circle) BOTH PARENTS AT HOME SOLE PARENT SHARED CARED OTHER ADDITIONAL DETAILS: CUSTODY ARRANGEMENTS If separated or divorced, who has legal custody of the child? (Please circle) Parent One Parent Two Both Parent 1 Access Arrangements? □ □ Full Limited Parent 2 Access Arrangements? □ □ Full Limited Are there any court orders, parent order or parenting plans relating to the powers □ □ Yes No and responsibilities of the parents in relation to the child or access to the child? (If Yes, please provide these details) Is anyone who is prohibited from having contact with the child? □ □ Yes No (If yes, please provide details). EMERGENCY CONTACTS AND AUTHORISATION Contact 1 FIRST NAME SURNAME RELATIONSHIP TO ADDRESS:
CONCESSION /HEALTH CARE CARD HOLDER? PREFERRED METHOD OF CONTACT? PARENT 2 PARENT 2 NAME PARENT 2 SURNAME PARENT 2 DATE OR PARENT 2 CRN: PARENT 2 EMAIL ADDRESS: PARENT 2 GENDER: FORMER NAMES PARENT HAS BEEN KNOWN BY ADDRESS: SUBURB: POSTCODE: PLACE OF BIRTH HOME PHONE WORK NUMBER MOBILE NUMBER LANGUAGE SPOKEN AT HOME OCCUPATION PLACE OF WORK: WORK STARTS: WORK FINISHES CONCESSION /HEALTH CARE CARD HOLDER? PREFERRED METHOD OF CONTACT? FAMILY STATUS (Please circle) BOTH PARENTS AT HOME SOLE PARENT SHARED CARED OTHER ADDITIONAL DETAILS: CUSTODY ARRANGEMENTS If separated or divorced, who has legal custody of the child? (Please circle) Parent One Parent Two Both Parent 1 Access Arrangements? □ Full □ Limited Parent 2 Access Arrangements? □ Full □ Limited Are there any court orders, parent order or parenting plans relating to the powers and responsibilities of the parents in relation to the child or access to the child? (If Yes, please provide these details) □ Yes □ No Is anyone who is prohibited from having contact with the child? (If yes, please provide details). □ Yes □ No EMERGENCY CONTACTS AND AUTHORISATION Contact 1 FIRST NAME SURNAME RELATIONSHIP TO ADDRESS:
child_enrolment_form_-_parent_handbook_june_2017.docx