College House Boarding Application Form

SECTION 1: BOARDER INFORMATION


I wish to enrol my son/daughter/ward at College House as a boarder in year:*
Year of Entry:*
Family Name*
Given Names*
Preferred Name: (if different to given name):
Date of Birth:*
Present School:*
Year Level:*
Nearest Secondary School:*
Distance in km:*
Distance from school bus route km:*

Mother’s/Guardian’s Details

Family Name (Mother/Guardian):*
Given Names (Mother/Guardian):*
Home Address (Mother/Guardian):*
Phone - Home (Mother/Guardian):
-
Phone - Work (Mother/Guardian):
-
Mobile phone (Mother/Guardian):
-
Fax (Mother/Guardian):
-
E-mail (Mother/Guardian):*

Father’s/Guardian’s Details

Family Name (Father/Guardian):*
Given Names (Father/Guardian):*
Home Address (Father/Guardian):*
Phone - Home (Father/Guardian):
-
Phone -Work (Father/Guardian):
-
Mobile phone (Father/Guardian):
-
Fax (Father/Guardian):
-
E-mail (Father/Guardian):*
Are you an overseas student:
Passport No:*
Visa Expiry Date:*

SECTION 2: EMERGENCY CONTACT

If Parent/Legal Guardian is unavailable

(The Legal Guardian is the person who has the right to control the student and make decisions with regard to upbringing and education).

Title (Emergency Contact):
Family Name (Emergency Contact):
Given Name (Emergency Contact):
Relationship to Boarder (Emergency Contact):
Address (Emergency Contact):
Phone (home - Emergency Contact):
-
Phone (work - Emergency Contact):
-
Mobile phone (Emergency Contact):
-

SECTION 4: PERSONAL INFORMATION


SECTION 3: MEDICAL

(All information provided is confidential)

Doctor’s Name:
Phone - Doctor:
-
Dentist’s Name:
Phone - Dentist:
-
Does your child suffer from any of the following: (Please Tick)*

SECTION 4: ADDITIONAL INFORMATION


Where to send Newsletters:
Where to send accounts:
Where to send correspondence/reports:

I/We agree that my son/daughter/ward shall be subject to the Codes of Conduct and Discipline of College House, to abide by the Hostel fees policy of the Board Of Trustees.

First Persons Name:*
Second Persons Name:*
Date:*