STUDENT DETAILS

Please list all students at Springfield Central State High School these changes are applicable to:

Student legal name *

Student family name *

Preferred name

Year level *Year 7Year 8Year 9Year 10Year 11Year 12

PARENT/GUARDIAN DETAILS

Parent/Guardian Legal Name *

Parent/Guardian Family Name *

Please enter the email address you would like to use for saving your progress on this form *

STEP 1 - PARENT / GUARDIAN DETAILS

Do you need to update the details for a Parent/Guardian? *

Parent/Guardian OneParent/Guardian TwoAdding additional Parent/GuardianNo updates to Parent/Guardians required (Please go to next page to submit)

PARENT/GUARDIAN ONE

Please only complete relevant details to be changed.

Parent/Guardian One Legal Name

Parent/Guardian One Family Name

Relationship to student

Emergency contact

YesNo

Resides with student

YesNo

Receives correspondence

YesNo

Receives SMS

YesNo

Preferred correspondence method

EmailPost

Occupation/workplace

Mobile number

Work number

Home number

Email address

Address

Suburb/ Postcode

Country of Birth / Main Language

Residency Status

Occupation GroupGroup 1: Senior managementGroup2: Other business managersGroup 3: TradespeopleGroup 4: Machine operatorsGroup 8: Not paid in the last 12 months

School Education LevelYear 9 or equivalent or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalent

Non-School Education LevelCertificate I to IVAdvanced diploma/diplomaBachelor degree or aboveNo non-school qualification

Blue card details (if applicable)

PARENT/GUARDIAN TWO OR ADDITIONAL PARENT/GUARDIAN

Please only complete relevant details to be changed.

Parent/Guardian Two Legal Name

Parent/Guardian Two Family Name

Relationship to student

Emergency contact

YesNo

Resides with student

YesNo

Receives correspondence

YesNo

Receives SMS

YesNo

Preferred correspondence method

EmailPost

Occupation/workplace

Mobile number

Work number

Home number

Email address *

Address

Suburb/ Postcode

Country of birth/ Main language

Residency status

Occupation GroupGroup 1: Senior managementGroup 2: Other business managersGroup 3: TradespeopleGroup 4: Machine operatorsGroup 8: Not paid in the last 12 months

School Education Level Year 9 or equivalent or belowYear 10 or equivalentYear 11 or equivalentYear 12 or equivalent

Non-School Education LevelCertificate I to IVAdvanced diploma/diplomaBachelor degree or aboveNo non-school qualification

Blue card details (if applicable)

STEP 2 - MEDICAL CONDITIONS - INCLUDING ALLERGIES

Are there medical conditions, including allergies, to update for your student/s? *

YesNo

Name of student

Medical condition

Symptoms

Management

Medication

Is there an Individual Management Plan available for your student for anaphylaxis, diabetes, asthma, epilepsy, or other conditions, if necessary?

Yes - if yes, please attach belowNoNot necessary

Upload Individual Management Plan (if necessary)

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STEP 3 - EMERGENCY CONTACTS

Would you like to *

Replace existingAdd to existingNo updates required

Please include a minimum of one additional emergency contact other than the parent/guardians linked to your student/s.

Emergency contact priority number123456

Legal name

Family name

Mobile number

Relationship to student

STEP 4 - FINANCIAL PARENT/GUARDIAN

Do you need to update the parent/guardian responsible for the student/s finances? *

YesNo (proceed to next section)

Financially responsible Parent/Guardian legal name

Financially responsible Parent/Guardian Family name

Financially responsible Parent/Guardian signature

Draw signature|Type signatureClear

Effective date

DECLARATION

By signing this form, you are confirming all information supplied is true and correct.

Parent/Guardian signature *

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Date *

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