Entry Year (Eg. 2022) Please select202120222023202420252026202720282029

Year Level of Application: Please selectPrepYear 1Year 2Year 3Year 4Year 5Year 6Year 7Year 8Year 9Year 10Year 11Year 12

Campus

Mt Ridley

Donnybrook

Siblings:

Does your child currently have a sibling attending Hume Anglican Grammar?

Yes

No

Sibling Name/s

Sibling Year Level Please selectPrepYear 1Year 2Year 3Year 4Year 5Year 6Year 7Year 8Year 9Year 10Year 11Year 12

Student Details:

Student Details:

Given Name

Surname

Other Names

Date of Birth

Gender

Male

Female

Religion Please selectAnglicanBuddhistCatholicOther ChristianChurch of ChristCopic OrthodoxGreek OrthodoxHinduIslamJehovahs WitnessLatter-Day SaintsLutheranMethodistMiscellaneous ReligionsMuslimNo Religious DemonimationOther OrthodoxPentecostalProtestantPresbyterianSeventh Day AdventistSikhismUniting

Victorian Student Number (if known/applicable)

Name of Current School or Kindergarten

Number of Years Enrolled at Current School or Kindergarten

Nationality

Country of Birth

Country of Birth - Select -AustraliaOther…

Enter other…

If born Overseas, date student commenced school in Australia

Is the student of Aboriginal or Torres Strait Islander origin?

No

Yes, Aboriginal

Yes, Torres Strait Islander

Yes, both Aboriginal and Torres Strait Islander

Student Citizenship Status Required (Government Requirement)

Australian Citizen Born in Australia

Australian Citizen Not Born in Australia

Not Currently Australian Citizen

Australian Passport Number & Document of Travel Attached

Visa subclass number recorded on entry to Australia

Date of arrival into Australia

Permanent Resident & Visa Subclass No.

Temporary Resident & Visa Subclass No.

Other & Visa Subclass No.

Languages

Language spoken at Home

Medical Information

Please specify any medical conditions the student suffers from eg. asthma, anaphylaxis, diabetes and/or any prescribed medications taken by the student.

Allergies: Please list any know allergies the student has eg. allergy to nuts, penicillin, bee stings etc.

Is there any other medical / health information that the School needs to be aware of?

Yes

No

If Yes, please provide comment

Consent to Medical Attention Additional NeedsThis application gives you the opportunity to provide information that will facilitate the smooth transition of your child into our school. It will assist the school to develop appropriate strategies to meet the particular needs of your child. If the information provided is incomplete or misleading, any decision made as to this enrolment may be revised.

Does your child have:

Autism

Behaviour Disorders

Hearing Impairment

Intellectual Disability

Language Disorder

Mental Health Issues

ADD/ADHD

Vision Impairment

Acquired Brain Injury

Other

If Other, please specify…

Where applicable, please assist us by providing the following information:

Additional Learning Needs (Please provide all relevant information)

Medical / allied health professional reports attached (please provide all relevant information)

Is your child currently receiving integration funding due to a disability?