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359 Arthur Street,
Dayton WA 6055
(08) 9232 5000
admin@emmaus.wa.edu.au
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Name of Parent/Responsible Person
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
Name of Partner
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
Number of Children to enrol
One
Two
Three
First Child Details
First Child's Name
*
First
Middle
Last
First Child Starting Year
*
Pre-Kindy
Kindy
Pre-Primary
Yr One
Yr Two
Yr Three
Yr Four
Yr Five
Yr Six
First Child Date of Birth
*
DD slash MM slash YYYY
First Child Gender (M/F)
*
Male
Female
Second Child Details
Second Child's Name
First
Middle
Last
Second Child Starting Year
Pre-Kindy
Kindy
Pre-Primary
Yr One
Yr Two
Yr Three
Yr Four
Yr Five
Yr Six
Second Child Date of Birth
DD slash MM slash YYYY
Second Child Gender (M/F)
Male
Female
Third Child Details
Third Child's Name
First
Middle
Last
Third Child Starting Year
Pre-Kindy
Kindy
Pre-Primary
Yr One
Yr Two
Yr Three
Yr Four
Yr Five
Yr Six
Third Child Date of Birth
DD slash MM slash YYYY
Third Child Gender (M/F)
Male
Female
Family Details
Residential Address
*
Street Address
Address Line 2
Suburb
Post Code
Postal Address
Same as Residential
Different to Residential
Postal Address
*
Street Address
Address Line 2
Suburb
Post Code
Home/Primary Phone
*
Work Phone
Mobile Phone
Email
*
Requested Start Date
DD slash MM slash YYYY
Are there any Family Court Orders regarding the day to day or long term care, welfare and development of the child?
Yes
No
Religious Denomination
Catholic
N/A
Other
Please specify other Religious Denomination
If applicable, name of school at which the child is currently or was last enrolled
Parents Occupations
*
Permanent Resident of Australia?
Yes
No
Please indicate date entered Australia
DD slash MM slash YYYY
VISA SUB CLASS No.
Disability/Medical conditions?
Yes
No
Disabilty/Medical Condition
Yes
No
Physical
Intellectual
Other
Medical Condition
Please outline nature of disability/medical condition
I/we have completed this initial application form to the best of my/our knowledge. I/we are aware that other forms and supporting documents may be required at a later stage:
Yes
How did you find out about us?
Word of mouth/recommendation
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Menu
HOME
ENROLMENT
Why Emmaus Catholic Primary School?
Online Enrolment
Fees & Charges
Application for Admission
ABOUT
School History
Term Dates
Values & Vision
School Crest
Newsletters
Policies
LIFE AT EMMAUS
Catholic Identity
Student Support
Student Leadership/Student Voice
CURRICULUM
Learning
Reporting
COMMUNITY
Parish
Outside of School Hours Care
CONTACT
EMPLOYMENT
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